NPIMap

Organization Active NPI

Rush-Copley Medical Group NFP

  • Family Medicine Physician
  • Aurora, IL
National Provider Identifier
1639455173
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-115418 Issued in IL
Legal business name
RUSH-COPLEY MEDICAL GROUP NFP
Practice address
2040 Ogden Ave
Suite 303
Aurora, IL 60504-7206
Phone
(630) 499-2329
Fax
(630) 898-5837
NPI assigned
Oct 28, 2011
Last updated
Feb 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Authorized official

Name
Marcee A. Brummel
Title
Executive Director
Phone
(630) 978-4915

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-115418 IL Primary
Adolescent Medicine (Family Medicine) Physician 207QA0000X 036-115418 IL
Adult Medicine Physician 207QA0505X 036-115418 IL

Addresses

Primary practice location

2040 Ogden Ave
Suite 303
Aurora, IL 60504-7206

Mailing address

1256 Waterford Dr Ste 230
Aurora, IL 60504-4511
Phone (630) 499-2404

Other identifiers 1

IdentifierTypeStateIssuer
036-115418MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310001029 IL Part B Supplier - Clinic/Group Practice 7618864877 Receives reassigned benefits from 188 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aurora, IL; Naperville, IL; North Aurora, IL; Oswego, IL; Plainfield, IL; Sugar Grove, IL; Yorkville, IL

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Locations

1256 Waterford Dr
Ste 230
Aurora, IL 60504
Phone (630) 499-2404

444 N Eola Rd
Ste 110
Aurora, IL 60502
Phone (630) 692-5660

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1319760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1639455173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 WATERFORD DR STE 230",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044511",
            "telephone_number": "630-499-2404",
            "fax_number": "630-692-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 OGDEN AVE",
            "address_2": "SUITE 303",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047206",
            "telephone_number": "630-499-2329",
            "fax_number": "630-898-5837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSH-COPLEY MEDICAL GROUP NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-28",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "BRUMMEL",
        "authorized_official_first_name": "MARCEE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-978-4915"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-115418",
            "primary": true
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "IL",
            "license": "036-115418",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "IL",
            "license": "036-115418",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-115418",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.