NPIMap

Organization Active NPI

Mercy Health System Corporation

Doing business as Mercy Crystal Lake OB GYN

  • Durable Medical Equipment & Medical Supplies
  • Crystal Lake, IL
National Provider Identifier
1508983784
Registry record updated Jan 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
310800 Issued in WI
Legal business name
MERCY HEALTH SYSTEM CORPORATION
Doing business as
Mercy Crystal Lake OB GYN
Practice address
750 E Terra Cotta Ave
Ste B
Crystal Lake, IL 60014-3621
Phone
(815) 459-1212
NPI assigned
Mar 23, 2007
Last updated
Jan 6, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2009

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

Authorized official

Name
John W Cook
Title
VP Cfo
Phone
(608) 756-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 310800 WI Primary

Addresses

Primary practice location

750 E Terra Cotta Ave
Ste B
Crystal Lake, IL 60014-3621

Mailing address

1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6000

Other identifiers 1

IdentifierTypeStateIssuer
14D0411934OtherCLIA

Other names 1

  • MERCY CRYSTAL LAKE OB GYN Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mercy Walworthphysician16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231200000000",
    "number": "1508983784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482940",
            "telephone_number": "608-756-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E TERRA COTTA AVE",
            "address_2": "STE B",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143621",
            "telephone_number": "815-459-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH SYSTEM CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY ALLIANCE INC",
        "enumeration_date": "2007-03-23",
        "last_updated": "2009-01-06",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VP CFO",
        "authorized_official_telephone_number": "608-756-6000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "310800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0411934",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY CRYSTAL LAKE OB GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2009; 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.