NPIMap

Organization Active NPI

Adventist Bolingbrook Hospital

Doing business as Adventhealth Bolingbrook

  • Cardiovascular Disease Physician
  • Bolingbrook, IL
National Provider Identifier
1477790160
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
ADVENTIST BOLINGBROOK HOSPITAL
Doing business as
Adventhealth Bolingbrook
Bolingbrook Hospital Cardiology
Uchicago Medicine Adventhealth Bolingbrook
Practice address
500 Remington Blvd
Bolingbrook, IL 60440-4906
Phone
(630) 312-5000
NPI assigned
Jan 16, 2009
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Tristan Shaw
Title
Chief Financial Officer
Phone
(630) 312-6008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary

Addresses

Primary practice location

500 Remington Blvd
Bolingbrook, IL 60440-4906

Mailing address

500 Remington Blvd
Bolingbrook, IL 60440-4906
Phone (630) 312-5000

Other identifiers 1

IdentifierTypeStateIssuer
IL1794OtherILMEDICARE GROUP PTAN

Other names 3

  • ADVENTHEALTH BOLINGBROOK Doing business as
  • Bolingbrook Hospital Cardiology Doing business as
  • UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090428000424 IL Part B Supplier - Clinic/Group Practice 1456449396 Receives reassigned benefits from 23 practitioners
1 other NPI on this enrollment
Practice locations: Bolingbrook, IL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Adventist Bolingbrook Hosp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1477790160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404906",
            "telephone_number": "630-312-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404906",
            "telephone_number": "630-312-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST BOLINGBROOK HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-16",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "630-312-6008"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "IL1794",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVENTHEALTH BOLINGBROOK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADVENTHEALTH BOLINGBROOK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bolingbrook Hospital Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.

Verify at the official NPI Registry.