NPIMap

Organization Active NPI

Northshore University Healthsystem Faculty Practice Associates

Doing business as NorthShore Radiology Group

  • Diagnostic Radiology Physician
  • Evanston, IL
National Provider Identifier
1710140496
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0000646 Issued in IL
Legal business name
NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES
Doing business as
NorthShore Radiology Group
Practice address
2650 Ridge Ave
Dept of Radiology, G507
Evanston, IL 60201-1718
Phone
(847) 570-2553
NPI assigned
Jul 3, 2008
Last updated
May 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Authorized official

Name
Dr. Joseph GolbusNPI 1215976410
Title
President
Phone
(847) 570-2503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0000646 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Dept of Radiology, G507
Evanston, IL 60201-1718

Mailing address

2650 Ridge Ave
Dept of Radiology, G507
Evanston, IL 60201-1718
Phone (847) 570-2553

Other identifiers 2

IdentifierTypeStateIssuer
DA8052OtherILRAILROAD
1632065OtherILBCBS

Other names 1

  • NorthShore Radiology Group Doing business as

National Provider Directory

National Provider Directory

Locations

2650 Ridge Ave
#G507
Evanston, IL 60201
Phone (847) 570-2475

7900 Rollins Rd
Gurnee, IL 60031
Phone (847) 356-8444

9600 Gross Point Rd
Ste 1374A
Skokie, IL 60076

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431302400000",
    "number": "1710140496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "DEPT OF RADIOLOGY, G507",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "DEPT OF RADIOLOGY, G507",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2015-05-11",
        "status": "A",
        "authorized_official_last_name": "GOLBUS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-570-2503",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "0000646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "DA8052",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1632065",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthShore Radiology Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; 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.