NPIMap

Organization Active NPI

Edward Health Ventures

  • Psychiatry Physician
  • Woodridge, IL
National Provider Identifier
1710938295
Registry record updated Apr 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EDWARD HEALTH VENTURES
Practice address
3540 Seven Bridges Dr
Ste 230
Woodridge, IL 60517-1222
Phone
(630) 964-9400
Fax
(630) 964-9375
NPI assigned
May 12, 2006
Last updated
Apr 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2010

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

Authorized official

Name
Mr. William G. Kottman
Title
President
Phone
(630) 646-3950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

3540 Seven Bridges Dr
Ste 230
Woodridge, IL 60517-1222

Mailing address

3540 Seven Bridges Drive
Ste 230
Woodridge, IL 60517-1222
Phone (630) 964-9400

Other identifiers 2

IdentifierTypeStateIssuer
036047726 1MedicaidIL
2234315OtherILBCBS

Other names 1

  • Linden Oaks Medical Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000616 IL Part B Supplier - Clinic/Group Practice 4284531484 Receives reassigned benefits from 656 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

1200 S York St
Ste 1240
Elmhurst, IL 60126
Phone (331) 221-6140

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1710938295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 SEVEN BRIDGES DRIVE",
            "address_2": "STE 230",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171222",
            "telephone_number": "630-964-9400",
            "fax_number": "630-964-9375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 SEVEN BRIDGES DR",
            "address_2": "STE 230",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171222",
            "telephone_number": "630-964-9400",
            "fax_number": "630-964-9375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD HEALTH VENTURES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "KOTTMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-646-3950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036047726 1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2234315",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Linden Oaks Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woodridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; 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.