Ophthalmology Surgery Center of Illinois, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC

Practice address

1300 N Arlington Heights Rd Ste 150
Itasca, IL 60143-3128

Phone

(630) 634-2980

Fax

(630) 625-8116

NPI assigned

Jun 6, 2019

Organization subpart

No

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

Authorized official

Name

Kevin J Kovach, MD

Title

President

Phone

(630) 634-2980

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Ophthalmology Surgery Center of Illinois LLCCCN 14C0001182

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1497314181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N ARLINGTON HEIGHTS RD STE 150",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601433128",
            "telephone_number": "630-634-2980",
            "fax_number": "630-625-8116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N ARLINGTON HEIGHTS RD STE 150",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601433128",
            "telephone_number": "630-634-2980",
            "fax_number": "630-625-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "KOVACH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-634-2980",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMBULATORY SURGICAL CENTER LICENSE",
            "identifier": "248002884",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Itasca, IL
• Providers in Itasca, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; 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.