NPIMap

Organization Active NPI

Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Burr Ridge, IL
National Provider Identifier
1669797734
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Practice address
901 MC Clintock Drive
Suite 202
Burr Ridge, IL 60527-0844
Phone
(630) 655-6742
Fax
(630) 734-4715
NPI assigned
Apr 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Authorized official

Name
Tara Kowalski
Title
Credentialing Manager
Phone
(888) 220-6432

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X

Addresses

Primary practice location

901 MC Clintock Drive
Suite 202
Burr Ridge, IL 60527-0844

Mailing address

901 MC Clintock Drive
Suite 202
Burr Ridge, IL 60527-0844
Phone (888) 220-6432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000274 IL Part B Supplier - Clinic/Group Practice 3072425784 Receives reassigned benefits from 138 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1669797734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MC CLINTOCK DRIVE",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270844",
            "telephone_number": "888-220-6432",
            "fax_number": "630-734-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MC CLINTOCK DRIVE",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270844",
            "telephone_number": "630-655-6742",
            "fax_number": "630-734-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO INFECTIOUS DISEASE CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "KOWALSKI",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "888-220-6432"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; 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.