Invictus Phoenix NFP

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

INVICTUS PHOENIX NFP

Practice address

1314 Pam Anne Dr
Glenview, IL 60025-2517

Phone

(847) 630-1164

NPI assigned

Jul 10, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Rupal M Potnis, MD

Title

Board Secretary

Phone

(847) 630-1164

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1700564614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 PAM ANNE DR",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600252517",
            "telephone_number": "847-630-1164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 PAM ANNE DR",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600252517",
            "telephone_number": "847-630-1164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INVICTUS PHOENIX NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "POTNIS",
        "authorized_official_first_name": "RUPAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BOARD SECRETARY",
        "authorized_official_telephone_number": "847-630-1164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.