NPIMap

Organization Active NPI

Iroquois Memorial Hospital

  • Surgery Physician
  • Watseka, IL
National Provider Identifier
1598081218
Registry record updated Apr 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
IROQUOIS MEMORIAL HOSPITAL
Practice address
625 S 5TH St
Watseka, IL 60970-1835
Phone
(815) 432-3305
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2010

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

Authorized official

Name
Dennis Wittenborn
Title
Board Chair
Phone
(815) 432-5841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

625 S 5TH St
Watseka, IL 60970-1835

Mailing address

625 S 5TH St
Watseka, IL 60970-1835
Phone (815) 432-3305

Other names 1

  • IMH General Surgeons Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040517000306 IL Part B Supplier - Clinic/Group Practice 4385551258 Receives reassigned benefits from 75 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Anne, IL; Watseka, IL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271721600000",
    "number": "1598081218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S 5TH ST",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701835",
            "telephone_number": "815-432-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 S 5TH ST",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701835",
            "telephone_number": "815-432-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2010-04-20",
        "status": "A",
        "authorized_official_last_name": "WITTENBORN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "BOARD CHAIR",
        "authorized_official_telephone_number": "815-432-5841"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMH General Surgeons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watseka, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.