NPIMap

Organization Active NPI

Integra Medical Doctors Inc

  • Specialist
  • Hoffman Estates, IL
National Provider Identifier
1700189677
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
INTEGRA MEDICAL DOCTORS INC
Practice address
2815 Forbs Ave
Suite 126
Hoffman Estates, IL 60192-3702
Phone
(708) 529-7359
Fax
(866) 264-2030
NPI assigned
Dec 14, 2010
Last updated
Apr 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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

Authorized official

Name
Mr. Glenn Manguerra
Title
President
Phone
(708) 529-7359

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

2815 Forbs Ave
Suite 126
Hoffman Estates, IL 60192-3702

Mailing address

2815 Forbs Ave
Suite 126
Hoffman Estates, IL 60192-3702

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110323000749 IL Part B Supplier - Clinic/Group Practice 9830372192 Receives reassigned benefits from 16 practitioners
Practice locations: Hoffman Estates, IL

National Provider Directory

National Provider Directory

Locations

2815 Forbs Ave
#126
Hoffman Estates, IL 60192
Phone (708) 529-7359

2815 Forbs Ave
Ste 126
Hoffman Estates, IL 60192
Phone (708) 529-7359

4020 W 111th St
Ste 207
Oak Lawn, IL 60453
Phone (708) 529-7359

655 S 8th St
West Dundee, IL 60118
Phone (708) 529-7359

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": "1292284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1700189677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2815 FORBS AVE",
            "address_2": "SUITE 126",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601923702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 FORBS AVE",
            "address_2": "SUITE 126",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601923702",
            "telephone_number": "708-529-7359",
            "fax_number": "866-264-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRA MEDICAL DOCTORS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-14",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "MANGUERRA",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-529-7359",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoffman Estates, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; 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.