Edward Health Ventures

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EDWARD HEALTH VENTURES

Doing business as

Edward Medical Group - Walk In Clinic

Practice address

15905 S Frederick St Ste 105
Plainfield, IL 60586-2212

Phone

(630) 646-5020

Fax

(630) 646-5025

NPI assigned

Jan 29, 2010

Last updated

Feb 11, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William Kottman

Title

President

Phone

(630) 646-3950

Specialties & licenses 1

Addresses

Other names 1

• Edward Medical Group - Walk In Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265846400000",
    "number": "1518298629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15905 S FREDERICK ST STE 105",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605862212",
            "telephone_number": "630-646-5020",
            "fax_number": "630-646-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15905 S FREDERICK ST STE 105",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605862212",
            "telephone_number": "630-646-5020",
            "fax_number": "630-646-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD HEALTH VENTURES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2010-02-11",
        "status": "A",
        "authorized_official_last_name": "KOTTMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-646-3950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edward Medical Group - Walk In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edward Health Services Corporation
• Edward Health Ventures
• Edward Health Ventures (Edward Medical Group)
• Edward Health Ventures
• Edward Health Ventures
• Edward Health Ventures (Edward Medical Group)
• Edward Health Ventures
• Edward Health Ventures (Edward Medical Group)
• Edward Hospital (Endeavor Health Laboratories in Plainfield)
• Edward Hospital Imaging Center Plainfield

• Family Medicine Physician in Plainfield, IL
• Providers in Plainfield, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; 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.