Individual provider Active NPI

Richard W Brinkman, M.D.

  • Surgery Physician
  • Downers Grove, IL
National Provider Identifier
1417964180
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036049777 Issued in IL
Practice address
1101 31St St Ste 170
Downers Grove, IL 60515-5581
Phone
(800) 991-6117
Fax
(888) 812-8191
NPI assigned
Aug 2, 2006
Last updated
May 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 38409 KY
Surgery Physician 208600000X 036049777 IL Primary

Addresses

Primary practice location

1101 31St St Ste 170
Downers Grove, IL 60515-5581

Mailing address

3810 Northdale Blvd Ste 150
Tampa, FL 33624-1871
Phone (813) 961-1331

Other identifiers 1

IdentifierTypeStateIssuer
64077696MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036049777ILMDSurgery Physician

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1417964180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 NORTHDALE BLVD STE 150",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241871",
            "telephone_number": "813-961-1331",
            "fax_number": "888-850-8316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 31ST ST STE 170",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155581",
            "telephone_number": "800-991-6117",
            "fax_number": "888-812-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRINKMAN",
        "first_name": "RICHARD",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "38409",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036049777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64077696",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

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