NPIMap

Organization Active NPI

Commonwealth Ear Nose & Throat-Head & Neck Center

  • Otolaryngology Physician
  • Carol Stream, IL
National Provider Identifier
1689732836
Registry record updated Sep 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER
Practice address
Department 8033
Carol Stream, IL 60122-8033
Phone
(502) 893-0159
NPI assigned
Dec 4, 2006
Last updated
Sep 22, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2009

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

Authorized official

Name
Ms. Harriet G Sellers
Title
Certified Coding Professional
Phone
(502) 893-0159

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

Department 8033
Carol Stream, IL 60122-8033

Mailing address

4004 Dupont Circle
Louisville, KY 40207
Phone (502) 893-0159

Other identifiers 3

IdentifierTypeStateIssuer
CB7082OtherRR MEDICARE PIN NUMBER
65912396MedicaidKY
100011000AMedicaidIN

National Provider Directory

National Provider Directory

Locations

Dept 8033
Carol Stream, IL 60122

30 VLG PLZ Dr
Shelbyville, KY 40065
Phone (502) 633-0839

30 VLG PLZ Dr
Shelbyville, KY 40065
Phone (502) 633-0839

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253577600000",
    "number": "1689732836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 DUPONT CIRCLE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40207",
            "telephone_number": "502-893-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPARTMENT 8033",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601228033",
            "telephone_number": "502-893-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-09-22",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "HARRIET",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CERTIFIED CODING PROFESSIONAL",
        "authorized_official_telephone_number": "502-893-0159",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN NUMBER",
            "identifier": "CB7082",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65912396",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100011000A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carol Stream, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2009; 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.