NPIMap

Organization Active NPI

Epic Group-Emergency Physicians an Illinois Concern S.C.

  • Emergency Medicine Physician
  • Morris, IL
National Provider Identifier
1447283569
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EPIC GROUP-EMERGENCY PHYSICIANS AN ILLINOIS CONCERN S.C.
Practice address
150 W High St
Morris, IL 60450-1463
Phone
(815) 942-0553
NPI assigned
Jul 9, 2006
Last updated
May 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Authorized official

Name
John Ellis Williamson, DONPI 1629017108
Title
Authorized Official
Phone
(708) 691-1253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

150 W High St
Morris, IL 60450-1463

Mailing address

PO Box 4777
Oak Brook, IL 60522-4777
Phone (866) 898-7147

Other identifiers 2

IdentifierTypeStateIssuer
03223219OtherILBLUE CROSS BLUE SHIELD
CG0558OtherILRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040806000102 IL Part B Supplier - Clinic/Group Practice 0345212841 Receives reassigned benefits from 31 practitioners
Practice locations: Morris, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1447283569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4777",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605224777",
            "telephone_number": "866-898-7147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W HIGH ST",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501463",
            "telephone_number": "815-942-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIC GROUP-EMERGENCY PHYSICIANS AN ILLINOIS CONCERN S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ELLIS",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "708-691-1253",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "03223219",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG0558",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.