NPIMap

Organization Active NPI

Swedishamerican Hospital

  • Family Medicine Physician
  • Roscoe, IL
National Provider Identifier
1386054062
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SWEDISHAMERICAN HOSPITAL
Practice address
4282 E Rockton Rd
Roscoe, IL 61073
Phone
(779) 696-9000
NPI assigned
May 2, 2014
Last updated
Jul 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Authorized official

Name
Don Daniels
Title
VP
Phone
(815) 966-2084

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Pulmonary Disease Physician 207RP1001X
Obstetrics & Gynecology Physician 207V00000X
Orthopaedic Surgery Physician 207X00000X
Surgery Physician 208600000X
Podiatrist 213E00000X

Addresses

Primary practice location

4282 E Rockton Rd
Roscoe, IL 61073

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866

Other identifiers 1

IdentifierTypeStateIssuer
082OtherILTRICARE SUFFIX #

Other names 1

  • SA Stateline Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000012 IL Part B Supplier - Clinic/Group Practice 5799698346 Receives reassigned benefits from 506 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Rockford, IL; Roscoe, IL; Belvidere, IL; Rochelle, IL; Freeport, IL; Davis Junction, IL; Byron, IL
O20100930020512 IL DME Supplier - Multi-Specialty - Physician 5799698346 1 other NPI on this enrollment
Practice locations: Roscoe, IL

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northern Illinois Surgery44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Locations

1340 Charles St
Ste 300
Rockford, IL 61104
Phone (779) 696-5888

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1386054062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4282 E ROCKTON RD",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "61073",
            "telephone_number": "779-696-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEDISHAMERICAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "815-966-2084"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SUFFIX #",
            "identifier": "082",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SA Stateline Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SA Stateline Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roscoe, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.