NPIMap

Organization Active NPI

Northwestern Medical Faculty Foundation

Doing business as Northwestern Medical Group

  • Optometrist
  • Chicago, IL
National Provider Identifier
1588063572
Registry record updated Aug 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NORTHWESTERN MEDICAL FACULTY FOUNDATION
Doing business as
Northwestern Medical Group
Practice address
259 E. Erie Street
Suite#02-220
Chicago, IL 60611-2661
Phone
(312) 695-8150
NPI assigned
Aug 15, 2014
Last updated
Aug 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2014

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

Authorized official

Name
Mr. Justin A. Johnson
Title
VP, Cfo
Phone
(312) 926-1599

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary
Corneal and Contact Management Optometrist 152WC0802X
Vision Therapy Optometrist 152WV0400X

Addresses

Primary practice location

259 E. Erie Street
Suite#02-220
Chicago, IL 60611-2661

Mailing address

680 N Lake Shore Dr
Suite#1000
Chicago, IL 60611-4546
Phone (312) 695-9797

Other names 1

  • Northwestern Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141125001928 IL DME Supplier - Multi-Specialty - PhysicianDME Supplier - Physician - OptometristDME Supplier - Optician 4587576814 Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Northwestern Foundation30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

259 E Erie St
Ste 2220
Chicago, IL 60611

NPI Registry JSON

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408060800000",
    "number": "1588063572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 N LAKE SHORE DR",
            "address_2": "SUITE#1000",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114546",
            "telephone_number": "312-695-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 E. ERIE STREET",
            "address_2": "SUITE#02-220",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112661",
            "telephone_number": "312-695-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN MEDICAL FACULTY FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-15",
        "last_updated": "2014-08-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "VP, CFO",
        "authorized_official_telephone_number": "312-926-1599",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwestern Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; 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.