NPIMap

Organization Active NPI

Obhg Illinois SC

  • Obstetrics & Gynecology Physician
  • Berwyn, IL
National Provider Identifier
1700107216
Registry record updated Jan 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OBHG ILLINOIS SC
Practice address
3249 Oak Park Ave
Berwyn, IL 60402-3429
Phone
(800) 967-2289
Fax
(864) 627-9920
NPI assigned
Jun 18, 2010
Last updated
Jan 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2019

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

Authorized official

Name
Dr. Lester C Jurgens, M.D.
Title
Ceo
Phone
(800) 967-2289

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Obstetrics & Gynecology Physician 207V00000X Primary
Hospitalist Physician 208M00000X

Addresses

Primary practice location

3249 Oak Park Ave
Berwyn, IL 60402-3429

Mailing address

777 Lowndes Hill Rd BLDG 1
Greenville, SC 29607-2131
Phone (800) 967-2289

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110314001065 IL Part B Supplier - Clinic/Group Practice 7810179702 Receives reassigned benefits from 217 practitioners
Practice locations: Moline, IL; Springfield, IL; Shiloh, IL; Quincy, IL; Oak Park, IL; O Fallon, IL; McHenry, IL; Kankakee, IL…

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 220

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 220

NPI Registry JSON

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547078400000",
    "number": "1700107216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 LOWNDES HILL RD BLDG 1",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296072131",
            "telephone_number": "800-967-2289",
            "fax_number": "864-627-9920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3249 OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023429",
            "telephone_number": "800-967-2289",
            "fax_number": "864-627-9920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBHG ILLINOIS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2019-01-10",
        "status": "A",
        "authorized_official_last_name": "JURGENS",
        "authorized_official_first_name": "LESTER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-967-2289",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jan 10, 2019; 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.