Family Medical Group of Lagrange

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

FAMILY MEDICAL GROUP OF LAGRANGE

Practice address

1415 W 47TH St
La Grange, IL 60525-6136

Phone

(708) 579-9375

Fax

(708) 579-9378

NPI assigned

Jul 4, 2006

Last updated

Dec 11, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Olga Bartolomeo

Title

Manager

Phone

(708) 579-9375

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1609806421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 W 47TH ST",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256136",
            "telephone_number": "708-579-9375",
            "fax_number": "708-579-9378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 W 47TH ST",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256136",
            "telephone_number": "708-579-9375",
            "fax_number": "708-579-9378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL GROUP OF LAGRANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "BARTOLOMEO",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-579-9375"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "521400",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiara Cang Escondo
• Cynthia Espinosa, OTR/L
• Evan J Fry, DMD PLLC (La Grange Dental Studio)
• Melinda Rose Fagan, M.S.
• Family Medical Center of Lagrange LTD
• Family Vision Care LLC
• Ella Farmer, PHD
• Carol Feldner
• Emily L Fetzer, M.A. CCC-SLP
• Fimreite Chiropractic, S.C.

• Exclusive Provider Organization in La Grange, IL
• Providers in La Grange, IL by specialty
• Exclusive Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.