NPIMap

Organization Active NPI

Avanti Medical Group of Illinois LLC

  • Clinic/Center
  • Wheaton, IL
National Provider Identifier
1609185875
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
AVANTI MEDICAL GROUP OF ILLINOIS LLC
Practice address
1755 S Naperville Rd
Suite 100
Wheaton, IL 60189-5844
Phone
(318) 465-5874
NPI assigned
Oct 5, 2010
Organization subpart
Yes
Parent organization
AVANTI MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Amy Graham, RN, BSN
Title
Vice President of Medical Affairs
Phone
(318) 465-5874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1755 S Naperville Rd
Suite 100
Wheaton, IL 60189-5844

Mailing address

1755 S Naperville Rd
Suite 100
Wheaton, IL 60189-5844
Phone (318) 465-5874

National Provider Directory

National Provider Directory

Locations

1485 Palatine Rd
Hoffman Estates, IL 60192
Phone (847) 202-0586

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1609185875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 S NAPERVILLE RD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895844",
            "telephone_number": "318-465-5874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 S NAPERVILLE RD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895844",
            "telephone_number": "318-465-5874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTI MEDICAL GROUP OF ILLINOIS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVANTI MEDICAL GROUP",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "VICE PRESIDENT OF MEDICAL AFFAIRS",
        "authorized_official_telephone_number": "318-465-5874",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.