NPIMap

Organization Active NPI

Digestive Diseases Consultants of Kankakee, SC

  • Gastroenterology Physician
  • Bourbonnais, IL
National Provider Identifier
1407966302
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIGESTIVE DISEASES CONSULTANTS OF KANKAKEE, SC
Practice address
1615 N. Convent St
Ste 1
Bourbonnais, IL 60914
Phone
(815) 937-5200
Fax
(815) 937-2063
NPI assigned
Aug 30, 2006
Last updated
Sep 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Authorized official

Name
Mrs. Christina M O'Connor
Title
Administrator
Phone
(815) 602-8253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X IL Primary

Addresses

Primary practice location

1615 N. Convent St
Ste 1
Bourbonnais, IL 60914

Mailing address

1615 N. Convent St
Ste 1
Bourbonnais, IL 60914
Phone (815) 937-5200

Other identifiers 1

IdentifierTypeStateIssuer
1407966302MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040518000722 IL Part B Supplier - Clinic/Group Practice 3476543646 Receives reassigned benefits from 16 practitioners
Practice locations: Bourbonnais, IL; Kankakee, IL; New Lenox, IL; Watseka, IL

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
14D0898770Digestive Diseases Consultants1615 N Convent St, Suite 1, Bourbonnais, IL 60914AccreditationDec 11, 2027

National Provider Directory

National Provider Directory

Locations

19001 Old Lagrange Rd
Fl 2
Mokena, IL 60448
Phone (708) 478-3600

1890 Silver Cross Blvd
Ste 225
New Lenox, IL 60451
Phone (815) 937-5200

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1407966302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 N. CONVENT ST",
            "address_2": "STE 1",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-937-5200",
            "fax_number": "815-937-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 N. CONVENT ST",
            "address_2": "STE 1",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-937-5200",
            "fax_number": "815-937-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASES CONSULTANTS OF KANKAKEE, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-602-8253",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407966302",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.