NPIMap

Organization Active NPI

Midwest Physician Group LTD.

  • Family Medicine Physician
  • Olympia Fields, IL
National Provider Identifier
1467405985
Registry record updated Dec 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42005377 Issued in IL
Legal business name
MIDWEST PHYSICIAN GROUP LTD.
Practice address
20110 Governors Hwy
Suite 1
Olympia Fields, IL 60461-1030
Phone
(708) 747-7960
Fax
(708) 503-3993
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2007

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

Authorized official

Name
Mr. Deborah J Nelson
Title
Chief Executive Officer
Phone
(708) 747-7960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 42005377 IL Primary

Addresses

Primary practice location

20110 Governors Hwy
Suite 1
Olympia Fields, IL 60461-1030

Mailing address

20110 Governors Hwy
Suite 1
Olympia Fields, IL 60461-1030
Phone (708) 747-7960

Other identifiers 6

IdentifierTypeStateIssuer
CA1946OtherILRAILROAD MEDICARE GROUP
CA7850OtherILRAILROAD MEDICARE GROUP
CD4066OtherILRAILROAD MEDICARE GROUP
C10237OtherILRAILROAD MEDICARE GROUP
0001616617OtherILBLUE SHIELD ID
CC6202OtherILRAILROAD MEDICARE GROUP

National Provider Directory

National Provider Directory
Tax ID family
Par Family Med Ctr3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1467405985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20110 GOVERNORS HWY",
            "address_2": "SUITE 1",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611030",
            "telephone_number": "708-747-7960",
            "fax_number": "708-503-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20110 GOVERNORS HWY",
            "address_2": "SUITE 1",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611030",
            "telephone_number": "708-747-7960",
            "fax_number": "708-503-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PHYSICIAN GROUP LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "708-747-7960",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "42005377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CA1946",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CA7850",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CD4066",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "C10237",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ID",
            "identifier": "0001616617",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CC6202",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; 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.