NPIMap

Organization Active NPI

Dr. Anthony Pendolino, LLC

  • Internal Medicine Physician
  • Plainfield, IL
National Provider Identifier
1508049149
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DR. ANTHONY PENDOLINO, LLC
Practice address
15715 S Route 59
Plainfield, IL 60544-2694
Phone
(815) 436-1191
NPI assigned
Dec 5, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Anthony Pendolino, D.C.NPI 1780779975
Title
Managing Member
Phone
(815) 436-1191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 1

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20051102000980 IL Part B Supplier - Clinic/Group Practice 8426076068 Receives reassigned benefits from 1 practitioner
Practice locations: Plainfield, IL

National Provider Directory

National Provider Directory
Tax ID family
Dr Anthony Pendolino LLC (2 organizations share this tax ID)

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

15715 S Route 59
Plainfield, IL 60544-2694

Mailing address

15715 S Route 59
Plainfield, IL 60544-2694
Phone (815) 436-1191

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
350039985OtherILRAILROAD MEDICARE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 22, 2020.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1508049149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15715 S ROUTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605442694",
            "telephone_number": "815-436-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15715 S ROUTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605442694",
            "telephone_number": "815-436-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ANTHONY PENDOLINO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "PENDOLINO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "815-436-1191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350039985",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.