NPIMap

Organization Active NPI

Diabetic Supply Center

  • Prosthetic/Orthotic Supplier
  • Berwyn, IL
National Provider Identifier
1497007595
Registry record updated Oct 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
212.000175 Issued in IL
Legal business name
DIABETIC SUPPLY CENTER
Practice address
6506 Cermak Rd
Berwyn, IL 60402-2323
Phone
(616) 835-3304
Fax
(312) 962-5724
NPI assigned
Oct 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2012

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

Authorized official

Name
Dallas Powers, CPED
Title
Managing Partner
Phone
(616) 835-3304

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X 212.000175 IL
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 212.000175 IL
Oxygen Equipment & Supplies (DME) 332BX2000X 212.000175 IL
Prosthetic/Orthotic Supplier 335E00000X 212.000175 IL Primary

Addresses

Primary practice location

6506 Cermak Rd
Berwyn, IL 60402-2323

Mailing address

6506 Cermak Rd
Berwyn, IL 60402-2323
Phone (616) 835-3304

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350000000000",
    "number": "1497007595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6506 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022323",
            "telephone_number": "616-835-3304",
            "fax_number": "312-962-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6506 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022323",
            "telephone_number": "616-835-3304",
            "fax_number": "312-962-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETIC SUPPLY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-10-12",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "616-835-3304",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": "212.000175",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "IL",
            "license": "212.000175",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "212.000175",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "212.000175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.