Organization Active NPI

FGL Lerner MD Services LTD

  • Adult Medicine Physician
  • Chicago, IL
National Provider Identifier
1417065087
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
FGL LERNER MD SERVICES LTD
Practice address
2100 S Indiana Ave
Ste 111
Chicago, IL 60616-1381
Phone
(312) 842-3700
Fax
(312) 842-3702
NPI assigned
Aug 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sherom Pitts
Title
Office Manager
Phone
(312) 842-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

2100 S Indiana Ave
Ste 111
Chicago, IL 60616-1381

Mailing address

2100 S Indiana Ave
Ste 111
Chicago, IL 60616-1381
Phone (312) 842-3700

National Provider Directory

National Provider Directory

Locations

2100 S Indiana Ave
Ste 111
Chicago, IL 60616
Phone (312) 842-3700

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417065087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 S INDIANA AVE",
            "address_2": "STE 111",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161381",
            "telephone_number": "312-842-3700",
            "fax_number": "312-842-3702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S INDIANA AVE",
            "address_2": "STE 111",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161381",
            "telephone_number": "312-842-3700",
            "fax_number": "312-842-3702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FGL LERNER MD SERVICES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PITTS",
        "authorized_official_first_name": "SHEROM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "312-842-3700"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; 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.