NPIMap

Organization Active NPI

Illinois Dermatology Institute, LLC

  • Medical Specialty Clinic/Center
  • Park Ridge, IL
National Provider Identifier
1447613989
Registry record updated Apr 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
036111710 Issued in IL
Legal business name
ILLINOIS DERMATOLOGY INSTITUTE, LLC
Practice address
1550 N Northwest Hwy
Suite 300
Park Ridge, IL 60068-1411
Phone
(847) 298-1831
Fax
(847) 298-1832
NPI assigned
Apr 1, 2016
Last updated
Apr 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2016

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

Authorized official

Name
Steven Mandrea, M.D.NPI 1386663631
Title
Physician
Phone
(847) 298-1831

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 036111710 IL Primary

Addresses

Primary practice location

1550 N Northwest Hwy
Suite 300
Park Ridge, IL 60068-1411

Mailing address

1550 N Northwest Hwy
Suite 300
Park Ridge, IL 60068-1411
Phone (847) 298-1831

Other identifiers 2

IdentifierTypeStateIssuer
036111710MedicaidIL
1386663631OtherILNPI

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
14D1071032Illinois Dermatology Institute1550 N Northwest Hwy, #300, Park Ridge, IL 60068ComplianceOct 4, 2027

National Provider Directory

National Provider Directory

Locations

1550 N Northwest Hwy
Ste 300
Park Ridge, IL 60068
Phone (847) 298-1831

Practitioners & affiliated clinicians

Practitioners 6

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": "1459468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1447613989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY",
            "address_2": "SUITE 300",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681411",
            "telephone_number": "847-298-1831",
            "fax_number": "847-298-1832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY",
            "address_2": "SUITE 300",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681411",
            "telephone_number": "847-298-1831",
            "fax_number": "847-298-1832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DERMATOLOGY INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-01",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "MANDREA",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "847-298-1831",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "036111710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111710",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1386663631",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.