Boulevard Pediatrics SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BOULEVARD PEDIATRICS SC

Practice address

30 E 15TH Street
Suite 205
Chicago Heights, IL 60411

Phone

(708) 755-4401

Fax

(708) 755-4479

NPI assigned

Oct 24, 2006

Organization subpart

No

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

Authorized official

Name

Antonio Marra, MDNPI 1225435225

Title

Owner

Phone

(708) 755-4401

Specialties & licenses 1

Addresses

Tax ID family

Antonio Marra2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Antonio Marra

  • Primary Care Clinic/Center
  • Chicago Heights, IL
  • NPI 1659777530
  NPD tax ID

Locations

Practitioners 1

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

• Antonio Marra, M.D.

  • Pediatrics Physician
  • Chicago Heights, IL
  • NPI 1225435225
  NPD (past) Authorized official

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558445122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E 15TH STREET",
            "address_2": "SUITE 205",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "60411",
            "telephone_number": "708-755-4401",
            "fax_number": "708-755-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E 15TH STREET",
            "address_2": "SUITE 205",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "60411",
            "telephone_number": "708-755-4401",
            "fax_number": "708-755-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARRA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-755-4401",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrill Binion
• Bloom Township School District 206
• Joseph P Bonanno, D.O.
• Gail D Bonds Carpenter
• Boulevard Medical Associates, SC
• Roshana Bowens
• Latrice Boyd
• Thomas Boyle, D.O.
• George Brassea III, LCPC
• Sara Brassea

• Pediatrics Physician in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Pediatrics Physician in Illinois

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