NPIMap

Organization Active NPI

Occu - Sports Med Corp

  • Specialist
  • Bellwood, IL
National Provider Identifier
1457344657
Registry record updated Nov 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036078552 Issued in IL
Legal business name
OCCU - SPORTS MED CORP
Doing business as
Advanced Occupational Medicine Specialists
Practice address
2615 Harrison St
Bellwood, IL 60104-2450
Phone
(708) 493-0199
Fax
(708) 493-9683
NPI assigned
Aug 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2010

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

Authorized official

Name
Castolina Solis, CPC
Title
Billing Manager
Phone
(708) 493-0199

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 036078552 IL Primary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 036078648 IL
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 036043379 IL

Addresses

Primary practice location

2615 Harrison St
Bellwood, IL 60104-2450

Mailing address

2615 Harrison St
Bellwood, IL 60104-2450
Phone (708) 493-0199

Other names 1

  • Advanced Occupational Medicine Specialists Doing business as

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1457344657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 HARRISON ST",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042450",
            "telephone_number": "708-493-0199",
            "fax_number": "708-493-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 HARRISON ST",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042450",
            "telephone_number": "708-493-0199",
            "fax_number": "708-493-9683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCCU - SPORTS MED CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "SOLIS",
        "authorized_official_first_name": "CASTOLINA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "708-493-0199",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036078552",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036078648",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036043379",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Occupational Medicine Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellwood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.