Premier Suburban Medical Group, PLLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

PREMIER SUBURBAN MEDICAL GROUP, PLLC

Practice address

17047 La Grange Rd.
Orland Park, IL 60487-1913

Phone

(815) 300-7764

NPI assigned

Aug 4, 2022

Organization subpart

No

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

Authorized official

Name

Refat Baridi

Title

Physician

Phone

(815) 300-7764

Specialties & licenses 1

Addresses

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/53113a2f-ce08-426c-a627-1d944f724a9e/

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1376270843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17047 LA GRANGE RD.",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604871913",
            "telephone_number": "815-300-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SUBURBAN MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-04",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "BARIDI",
        "authorized_official_first_name": "REFAT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "815-300-7764"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-Pharmacy Dispensing Site in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Non-Pharmacy Dispensing Site in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.