Brent T. Fonner, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036088383 Issued in IL

Practice address

Provena Mercy Medical Center / Pathology Department
1325 North Highland Avenue
Aurora, IL 60506

Phone

(630) 859-2222

NPI assigned

Aug 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

Northwestern University Feinberg Medical School, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aurora Radiology Consultants - Dekalb LLCGroup PAC ID 8628142106, 16 clinicians

Integrated Imaging Consultants LLCGroup PAC ID 2567784408, 163 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine Kishwaukee Hospital Hospital, Dekalb, IL, CCN 140286
• Advocate Good Samaritan Hospital Hospital, Downers Grove, IL, CCN 140288
• Valley West Community Hospital Hospital, Sandwich, IL, CCN 141340
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Copley Memorial Hospital Hospital, Aurora, IL, CCN 140029

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrated Imaging Consultants LLC

  • Diagnostic Radiology Physician
  • Park Ridge, IL
  • NPI 1700285335
  Medicare reassignment Care Compare group NPD
• Aurora Radiology Consultants - Dekalb LLC

  • Diagnostic Radiology Physician
  • Dekalb, IL
  • NPI 1801062831
  Medicare reassignment Care Compare group
• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Aurora, IL
  • NPI 1003542184
  Medicare reassignment NPD
• Aurora Radiology Consultants, S.C.

  • Diagnostic Radiology Physician
  • Aurora, IL
  • NPI 1053310417
  Medicare reassignment NPD
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Advocate Health and Hospitals Corporation

  • General Acute Care Hospital
  • Downers Grove, IL
  • NPI 1578670543
  Care Compare affiliation
• Central Dupage Hospital Association

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Copley Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Aurora, IL
  • NPI 1295882561
  Care Compare affiliation
• Kishwaukee Community Hospital

  • General Acute Care Hospital
  • Dekalb, IL
  • NPI 1669534517
  Care Compare affiliation
• Valley West Community Hospital

  • Critical Access Hospital
  • Sandwich, IL
  • NPI 1184705931
  Care Compare affiliation

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1477555308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E 22ND ST",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601486110",
            "telephone_number": "630-874-2542",
            "fax_number": "630-874-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PROVENA MERCY MEDICAL CENTER / PATHOLOGY DEPARTMENT",
            "address_2": "1325 NORTH HIGHLAND AVENUE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "60506",
            "telephone_number": "630-859-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONNER",
        "first_name": "BRENT",
        "middle_name": "T.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036088383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Aurora, IL
• Providers in Aurora, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.