NPIMap

Organization Active NPI

Nephrology Associates of Northern Illinois

  • Nephrology Physician
  • Crystal Lake, IL
National Provider Identifier
1447403852
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036110997 Issued in IL
Legal business name
NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Practice address
650 Dakota St
Suite C
Crystal Lake, IL 60012-3744
Phone
(815) 301-1001
Fax
(815) 301-1002
NPI assigned
Oct 29, 2008
Last updated
Nov 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Authorized official

Name
Mr. Brian O'Dea
Title
Cfo/Coo
Phone
(708) 386-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036110997 IL Primary

Addresses

Primary practice location

650 Dakota St
Suite C
Crystal Lake, IL 60012-3744

Mailing address

PO Box 94644
Cleveland, OH 44101-4644
Phone (630) 573-5000

Other identifiers 1

IdentifierTypeStateIssuer
1548210677OtherILPROVIDER NPI NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Nephrology Associates of Northern Illinois5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1447403852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94644",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014644",
            "telephone_number": "630-573-5000",
            "fax_number": "630-368-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST",
            "address_2": "SUITE C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123744",
            "telephone_number": "815-301-1001",
            "fax_number": "815-301-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-29",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "O'DEA",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "708-386-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036110997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI NUMBER",
            "identifier": "1548210677",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.