NPIMap

Organization Active NPI

Primesource Healthcare Systems, Inc.

  • Podiatrist
  • Buffalo Grove, IL
National Provider Identifier
1497704126
Registry record updated Feb 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Practice address
2100 East Lake Cook Road
Suite 1100
Buffalo Grove, IL 60089-1815
Phone
(800) 317-0711
Fax
(877) 821-6402
NPI assigned
May 9, 2006
Last updated
Feb 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2014

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

Authorized official

Name
Mr. David Fleming
Title
President & Ceo
Phone
(800) 317-0711

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Vision Therapy OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WV0400X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X

Addresses

Primary practice location

2100 East Lake Cook Road
Suite 1100
Buffalo Grove, IL 60089-1815

Mailing address

2100 East Lake Cook Road
Suite 1100
Buffalo Grove, IL 60089-1815
Phone (800) 317-0711

Other identifiers 4

IdentifierTypeStateIssuer
100052700MedicaidIN
200109050MedicaidIN
000000175113OtherINANTHEM
200378850AMedicaidIN

National Provider Directory

National Provider Directory

Member of 1

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

Locations

775 Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 267-8200

8902 N Meridian St
#2
Indianapolis, IN 46260

1001 N Grant St
Lebanon, IN 46052
Phone (765) 482-6400

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392768000000",
    "number": "1497704126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 EAST LAKE COOK ROAD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891815",
            "telephone_number": "800-317-0711",
            "fax_number": "877-821-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 EAST LAKE COOK ROAD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891815",
            "telephone_number": "800-317-0711",
            "fax_number": "877-821-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMESOURCE HEALTHCARE SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2014-02-19",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "800-317-0711",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100052700",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200109050",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000175113",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200378850A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; 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.