Active NPI
Amg Illinois LTD
- Durable Medical Equipment & Medical Supplies
- Fox Lake, IL
National Provider Identifier
1467696401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- AMG ILLINOIS LTD
- Practice address
- 81 E Grand Ave
Fox Lake, IL 60020-1557 - Phone
- (847) 587-0115
- Fax
- (847) 587-6246
- NPI assigned
- Apr 21, 2009
- Last updated
- Aug 31, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeffrey Bailet, MD
- Title
- President
- Phone
- (414) 647-6322
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary |
Addresses
Primary practice location
81 E Grand Ave
Fox Lake, IL 60020-1557
Mailing address
81 E Grand Ave
Fox Lake, IL 60020-1557
Phone (847) 587-0115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090512000348 | IL | Part B Supplier - Clinic/Group Practice | 8527117027 |
Receives reassigned benefits from 62 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Zion, IL; Waukegan, IL; Round Lake Beach, IL; Lindenhurst, IL; Libertyville, IL; Gurnee, IL |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Durable Medical Equipment & Medical Supplies
- Gurnee, IL
- NPI 1124262944
O20090512000348
-
dba AMG Illinois
- Durable Medical Equipment & Medical Supplies
- Zion, IL
- NPI 1699062141
O20090512000348
-
- Durable Medical Equipment & Medical Supplies
- Gurnee, IL
- NPI 1871873778
O20090512000348
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240272000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1251676800000",
"number": "1467696401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81 E GRAND AVE",
"city": "FOX LAKE",
"state": "IL",
"postal_code": "600201557",
"telephone_number": "847-587-0115",
"fax_number": "847-587-6246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81 E GRAND AVE",
"city": "FOX LAKE",
"state": "IL",
"postal_code": "600201557",
"telephone_number": "847-587-0115",
"fax_number": "847-587-6246"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMG ILLINOIS LTD",
"organizational_subpart": "NO",
"enumeration_date": "2009-04-21",
"last_updated": "2009-08-31",
"status": "A",
"authorized_official_last_name": "BAILET",
"authorized_official_first_name": "JEFFREY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "414-647-6322",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fox Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.