NPIMap

Organization Active NPI

Palos Community Hospital (Icc Physician Group)

  • Family Medicine Physician
  • Orland Park, IL
National Provider Identifier
1588797641
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PALOS COMMUNITY HOSPITAL (ICC PHYSICIAN GROUP)
Practice address
15300 West Ave
Orland Park, IL 60462-4600
Phone
(708) 460-5550
Fax
(708) 226-2630
NPI assigned
Mar 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Margaret Wright
Title
President
Phone
(708) 923-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

15300 West Ave
Orland Park, IL 60462-4600

Mailing address

15300 West Ave
Orland Park, IL 60462-4600
Phone (708) 460-5550

Other identifiers 1

IdentifierTypeStateIssuer
0001619045OtherINBLUE CROSS GROUP NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Palos Community Hospital - Private Duty6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588797641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624600",
            "telephone_number": "708-460-5550",
            "fax_number": "708-226-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624600",
            "telephone_number": "708-460-5550",
            "fax_number": "708-226-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALOS COMMUNITY HOSPITAL (ICC PHYSICIAN GROUP)",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-923-5000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "0001619045",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • 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.