George J Cloud Jr., OPA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

6850 Centennial Dr
Tinley Park, IL 60477-1653

Phone

(708) 429-3455

Fax

(708) 429-3422

NPI assigned

Aug 19, 2006

Last updated

Jul 24, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216857600000",
    "number": "1679687164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 CENTENNIAL DR",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771653",
            "telephone_number": "708-429-3455",
            "fax_number": "708-429-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 CENTENNIAL DR",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771653",
            "telephone_number": "708-429-3455",
            "fax_number": "708-429-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUD",
        "first_name": "GEORGE",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "OPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2008-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01620925",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; 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.