Organization Active NPI

Adventist Health Partners, Inc

Doing business as Plainfield Family Medicine

  • Family Medicine Physician
  • Plainfield, IL
National Provider Identifier
1407093099
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ADVENTIST HEALTH PARTNERS, INC
Doing business as
Plainfield Family Medicine
Practice address
23836 W 135TH St
Plainfield, IL 60544-5620
Phone
(815) 254-2403
Fax
(815) 267-8380
NPI assigned
Jan 19, 2009
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Mrs. Ruby Mann
Title
Director
Phone
(630) 856-6884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

23836 W 135TH St
Plainfield, IL 60544-5620

Mailing address

23836 135TH St
Ste 103
Plainfield, IL 60544-7009

Other names 1

  • Plainfield Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040127000064 IL Part B Supplier - Clinic/Group Practice 0244135762 Receives reassigned benefits from 392 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1095833Plainfield Family Medicine23836 135TH Street, Plainfield, IL 60544Provider-performed microscopyFeb 18, 2027

National Provider Directory

National Provider Directory

Locations

23836 W 135th St
Plainfield, IL 60544
Phone (815) 254-2403

23836 W 135th St
Unit 103
Plainfield, IL 60544
Phone (815) 254-2403

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1232323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1407093099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23836 135TH ST",
            "address_2": "STE 103",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605447009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23836 W 135TH ST",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605445620",
            "telephone_number": "815-254-2403",
            "fax_number": "815-267-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH PARTNERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-19",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "630-856-6884",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plainfield Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.