NPIMap

Organization Active NPI

Northwestern Medical Faculty Foundation

Doing business as Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
National Provider Identifier
1497308340
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
NORTHWESTERN MEDICAL FACULTY FOUNDATION
Doing business as
Northwestern Medical Group
Practice address
675 N Saint Clair St Ste 20-150
Chicago, IL 60611-5979
Phone
(312) 695-8146
Fax
(312) 695-7030
NPI assigned
Jul 19, 2019
Last updated
Jul 19, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWESTERN MEDICAL FACULTY FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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

Authorized official

Name
Russell B Cox
Title
Director
Phone
(312) 695-7860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 20-150
Chicago, IL 60611-5979

Mailing address

5777 Dept
Carol Stream, IL 60122-5777

Other names 1

  • Northwestern Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190930000412 IL DME Supplier - Physician - Urology 4587576814 Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0424014Northwestern Medical Group (NMG)675 N Saint Clair 18-200, Chicago, IL 60611Provider-performed microscopyOct 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Northwestern Foundation30 organizations share this tax ID, including this one
Part of
Northwestern Foundation

Other organizations with this tax ID 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563494400000",
    "number": "1497308340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5777 DEPT",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601225777",
            "fax_number": "312-695-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 20-150",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115979",
            "telephone_number": "312-695-8146",
            "fax_number": "312-695-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN MEDICAL FACULTY FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWESTERN MEDICAL FACULTY FOUNDATION",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "312-695-7860"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwestern Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.