NPIMap

Organization Active NPI

MD Orthotic and Prosthetic Laboratory, Inc

  • Prosthetic/Orthotic Supplier
  • Naperville, IL
National Provider Identifier
1376226910
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
MD ORTHOTIC AND PROSTHETIC LABORATORY, INC
Practice address
387 Shuman Blvd Ste 201E
Naperville, IL 60563-8306
Phone
(630) 283-1830
Fax
(630) 320-2282
NPI assigned
Aug 10, 2023
Last updated
Sep 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kendra F Mickelson
Title
Manager of Revenue Cycle Management
Phone
(309) 285-7752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X NU Primary

Addresses

Primary practice location

387 Shuman Blvd Ste 201E
Naperville, IL 60563-8306

Mailing address

741 W Main St
Peoria, IL 61606-1953
Phone (309) 285-7752

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc

National Provider Directory

National Provider Directory
Tax ID family
MD Orthotic and Prosthetic Laboratory Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1376226910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 W MAIN ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061953",
            "telephone_number": "309-285-7752",
            "fax_number": "309-285-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 SHUMAN BLVD STE 201E",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638306",
            "telephone_number": "630-283-1830",
            "fax_number": "630-320-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD ORTHOTIC AND PROSTHETIC LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "MICKELSON",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGER OF REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "309-285-7752"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.