NPIMap

Organization Active NPI

Proponent Medical Group,LTD

  • Otolaryngology Physician
  • Elgin, IL
National Provider Identifier
1720168024
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
042617550 Issued in IL
Legal business name
PROPONENT MEDICAL GROUP,LTD
Practice address
2350 Royal Blvd
Suite 500
Elgin, IL 60123-4719
Phone
(847) 697-3800
Fax
(847) 697-3804
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Dr. Lawrence F Berg, M.D.
Title
President
Phone
(847) 697-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 042617550 IL Primary

Addresses

Primary practice location

2350 Royal Blvd
Suite 500
Elgin, IL 60123-4719

Mailing address

2350 Royal Blvd
Suite 500
Elgin, IL 60123-4719
Phone (847) 697-3800

Other identifiers 1

IdentifierTypeStateIssuer
4532006OtherILBC/BS GROUP

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lberg282828@direct.myadvocateaurora.org Direct
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/API/fhir/dstu2/

National Provider Directory

National Provider Directory

Locations

2350 Royal Blvd
Ste 500
Elgin, IL 60123
Phone (847) 697-3800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1720168024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 ROYAL BLVD",
            "address_2": "SUITE 500",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234719",
            "telephone_number": "847-697-3800",
            "fax_number": "847-697-3804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 ROYAL BLVD",
            "address_2": "SUITE 500",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234719",
            "telephone_number": "847-697-3800",
            "fax_number": "847-697-3804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROPONENT MEDICAL GROUP,LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-697-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "042617550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP",
            "identifier": "4532006",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lberg282828@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1750 N Randall Rd Ste 210",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601237903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/API/fhir/dstu2/",
            "affiliation": "N",
            "address_1": "1750 N Randall Rd Ste 210",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601237903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.