Obhg Illinois SC
Organization Active NPI Obstetrics & Gynecology Physician · Berwyn, IL
NPI 1700107216 · NPPES record last updated Jan 10, 2019
Key facts
- NPI
- 1700107216
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Lester C Jurgens, M.D.
- Title
- Ceo
- Phone
- (800) 967-2289
Practitioners 220
-
Cherise Cokley, MD
-
Pamela Phillips Friye, D.O.
-
James Leo Gildner, M.D.
-
Samantha Lee Heywood, M.D.
-
Nickyla Johnson, MD
-
Sherry K Jones, MD
-
Katrina Lake, MD
-
Patrick Michel, M.D.
-
Janaki Nandam, D.O.
-
John E Perch, DO
-
Kimberly Elise Portale, D.O.
-
Verna J. Porter, MD
-
Toni M. Quinn, M.D.
-
Michael Ragland, MD
-
Donna J. Sweetland, M.D.
-
Rashmi C Tomur, M.D
-
Bryson Whalen, M.D.
-
Olufemi Ajibade, MD
-
Michael B Chen, M.D.
-
Jessica W Fivecoat, M.D.
-
Marc Luckett, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
333 Madison St
Joliet, IL 60435
Phone (815) 725-7222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | Yes | ||
| 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
Other providers in Berwyn, IL
- Benjamin Nunez
- Kylie O'Connell
- Chelsey O'Hanlon
- Kathleen Ann O'Hara
- Oakwell Illinois Physicians PLLC
- Sandra Ocampo
- Christopher Daniel Ochoa
- Oladimeji Ogbara
- Rebecca Annette Ogle
- Carrie Elizabeth Ohl
All providers in Berwyn, IL · Obstetrics & Gynecology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.