NPIMap

Organization Active NPI

Starsurgical

  • Surgery Physician
  • Montgomery, IL
National Provider Identifier
1376701805
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
238.000022 Issued in IL
Legal business name
STARSURGICAL
Practice address
2373 White Rose Dr
Montgomery, IL 60538-5140
Phone
(630) 330-1761
Fax
(630) 762-9681
NPI assigned
May 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Authorized official

Name
Jose Espino, RCSANPI 1407882210
Title
Physician
Phone
(630) 330-1761

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 238.000022 IL Primary

Addresses

Primary practice location

2373 White Rose Dr
Montgomery, IL 60538-5140

Mailing address

PO Box 88543
Carol Stream, IL 60188-0543
Phone (630) 330-1761

Other identifiers 3

IdentifierTypeStateIssuer
1407882210OtherILNPI FOR PROVIDER JOSE ESPINO
04732058OtherILBC PROVIDER NUMBER
1891095196OtherILNPI FOR MARIA KONIECZKO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1376701805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88543",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601880543",
            "telephone_number": "630-330-1761",
            "fax_number": "630-762-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 WHITE ROSE DR",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605385140",
            "telephone_number": "630-330-1761",
            "fax_number": "630-762-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARSURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "ESPINO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "630-330-1761",
        "authorized_official_credential": "RCSA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "238.000022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR PROVIDER JOSE ESPINO",
            "identifier": "1407882210",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC PROVIDER NUMBER",
            "identifier": "04732058",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR MARIA KONIECZKO",
            "identifier": "1891095196",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.