Active NPI
Phillip A. Boch, D.O.
- Family Medicine Physician
- Berwyn, IL
National Provider Identifier
1699767186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-054799
- Practice address
- 6320 Cermak Rd
Berwyn, IL 60402-2812 - Phone
- (708) 749-3777
- NPI assigned
- Aug 19, 2005
- Last updated
- Dec 6, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-054799 | IL | Primary |
Addresses
Primary practice location
6320 Cermak Rd
Berwyn, IL 60402-2812
Mailing address
6320 Cermak Rd
Berwyn, IL 60402-2812
Phone (708) 749-3777
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 363033456 | Other | IL | FEDERAL TAX ID |
| 9530608003 | Other | IL | CIGNA |
| 4656516 | Other | IL | AETNA |
| 120001237 | Other | IL | RAILROAD MEDICARE |
| 21607418 | Other | IL | BLUE CROSS BLUE SHIELD ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-054799 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291593600000",
"number": "1699767186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6320 CERMAK RD",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022812",
"telephone_number": "708-749-3777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6320 CERMAK RD",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022812",
"telephone_number": "708-749-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOCH",
"first_name": "PHILLIP",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-19",
"last_updated": "2010-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-054799",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "363033456",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "9530608003",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4656516",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "120001237",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD ID",
"identifier": "21607418",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.