NPIMap

Organization Active NPI

Dupage Medical Group LTD

Doing business as DuPage Medical Group

  • Clinical Medical Laboratory
  • Lisle, IL
National Provider Identifier
1528309291
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
042000124 Issued in IL
Legal business name
DUPAGE MEDICAL GROUP LTD
Doing business as
DuPage Medical Group
DuPage Medical Group, Ltd
Practice address
430 Warrenville Rd
Ste 210
Lisle, IL 60532-1348
Phone
(630) 432-6148
NPI assigned
Mar 6, 2013
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Paul Merrick, MDNPI 1679541643
Title
Chairman of the Board
Phone
(630) 790-1221

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 042000124 IL Primary

Addresses

Primary practice location

430 Warrenville Rd
Ste 210
Lisle, IL 60532-1348

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Other names 2

  • DuPage Medical Group Doing business as
  • DuPage Medical Group, Ltd Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130506000296 IL Part B Supplier - Independent Clinical Laboratory 5496667941 Practice locations: Lisle, IL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2048982Lisle Internal Medicine430 Warrenville Rd, Lisle, IL 60532Certificate of waiverOct 25, 2026
14D2049280Dupage Medical Group Immediate Care Center430 Warrenville Rd, Ste 230, Lisle, IL 60532Certificate of waiverOct 31, 2026
14D2113989Dupage Medical Group - Oncology430 Warrenville Rd, Ste 300, Lisle, IL 60532Certificate of waiverJun 2, 2028
14D2194946Du Page Medical Group - Lisle Radiology430 Warrenville Rd - Ste 110, Lisle, IL 60532Certificate of waiverOct 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
Glen Ellyn Allergy Dept35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

1206 E 9th St
Ste 200A
Lockport, IL 60441

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1528309291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 WARRENVILLE RD",
            "address_2": "STE 210",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321348",
            "telephone_number": "630-432-6148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUPAGE MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "MERRICK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "630-790-1221",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "042000124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DuPage Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DuPage Medical Group, Ltd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; 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.