Active NPI
Laura M Buthod, MD
- Pediatrics Physician
- Crystal Lake, IL
National Provider Identifier
1467400499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036086040
- Practice address
- 650 Dakota St Ste a
Crystal Lake, IL 60012 - Phone
- (815) 455-6000
- Fax
- (815) 356-1104
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036086040 | IL | Primary |
Addresses
Primary practice location
650 Dakota St Ste a
Crystal Lake, IL 60012
Mailing address
650 Dakota St Ste a
Crystal Lake, IL 60012-3744
Phone (815) 455-6000
Other practice location 1
360 Station Dr Fl 3
Crystal Lake, IL 60014
Phone (815) 338-6600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370022768 | Other | IL | MEDICARE RAILROAD |
| 036086040 | Other | IL | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036086040 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548892800000",
"number": "1467400499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 DAKOTA ST STE A",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600123744",
"telephone_number": "815-455-6000",
"fax_number": "815-356-1104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 DAKOTA ST STE A",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60012",
"telephone_number": "815-455-6000",
"fax_number": "815-356-1104"
}
],
"practiceLocations": [
{
"address_1": "360 Station Dr Fl 3",
"address_purpose": "LOCATION",
"city": "Crystal Lake",
"state": "IL",
"postal_code": "60014",
"country_code": "US",
"telephone_number": "815-338-6600",
"fax_number": "815-356-2320",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUTHOD",
"first_name": "LAURA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2019-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036086040",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "370022768",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "036086040",
"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 Jan 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.