NPIMap

Organization Active NPI

Orthopedic & Shoulder Center, S.C.

  • Orthopaedic Surgery Physician
  • Normal, IL
National Provider Identifier
1437453073
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
036092458 Issued in IL
Legal business name
ORTHOPEDIC & SHOULDER CENTER, S.C.
Practice address
2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290
Phone
(309) 454-1616
Fax
(309) 454-5167
NPI assigned
Dec 22, 2010
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Brandi Meisner
Title
Administrator
Phone
(309) 888-9800

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
14D2337159Orthopedic & Shoulder Center2200 Fort Jesse Rd - Ste 250, Normal, IL 61761RegistrationJan 19, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110420000193 IL Part B Supplier - Clinic/Group Practice 9537344403 Receives reassigned benefits from 7 practitioners
Practice locations: Normal, IL
O20111216000738 IL DME Supplier - Physician - Unknown Physician Specialty 9537344403 Practice locations: Normal, IL

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 036092458 IL Primary

Addresses

NPPES NPI Registry

Primary practice location

2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290

Mailing address

2200 Fort Jesse Road
Suite 250
Normal, IL 61761
Phone (309) 888-9800

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 21, 2015.

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1437453073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE ROAD",
            "address_2": "SUITE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "61761",
            "telephone_number": "309-888-9800",
            "fax_number": "309-828-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD STE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616290",
            "telephone_number": "309-454-1616",
            "fax_number": "309-454-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SHOULDER CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "MEISNER",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-888-9800"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036092458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; 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.