Organization Active NPI

Mary K Palmore MD SC

  • Obstetrics & Gynecology Physician
  • Chicago, IL
National Provider Identifier
1386697274
Registry record updated Apr 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MARY K PALMORE MD SC
Practice address
3641 E 108TH St
Chicago, IL 60617-6951
Phone
(773) 731-5466
Fax
(773) 731-5461
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2015

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

Authorized official

Name
Mary K Palmore, MD
Title
Owner
Phone
(773) 779-8285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X IL Primary

Addresses

Primary practice location

3641 E 108TH St
Chicago, IL 60617-6951

Mailing address

PO Box 5543
Chicago, IL 60680-5543
Phone (773) 779-8285

Other identifiers 3

IdentifierTypeStateIssuer
14D0996652OtherILCLIA
DG8319OtherILRAILROAD MEDICARE
01627483OtherILBCBS

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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1386697274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5543",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606805543",
            "telephone_number": "773-779-8285",
            "fax_number": "773-779-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3641 E 108TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606176951",
            "telephone_number": "773-731-5466",
            "fax_number": "773-731-5461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY K PALMORE MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "PALMORE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-779-8285",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0996652",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG8319",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01627483",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; 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.