NPIMap

Organization Active NPI

Fischer Mangold/Joliet

  • Emergency Medicine Physician
  • Joliet, IL
National Provider Identifier
1730138496
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
FISCHER MANGOLD/JOLIET
Practice address
1200 Maple Rd
Joliet, IL 60432-1439
Phone
(925) 924-1600
Fax
(925) 924-0506
NPI assigned
May 9, 2006
Last updated
Oct 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

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

Authorized official

Name
Dr. Richard D. Carvolth, M.D.NPI 1932159829
Title
President
Phone
(925) 924-1600

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
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1200 Maple Rd
Joliet, IL 60432-1439

Mailing address

PO Box 634717
Cincinnati, OH 45263-0001
Phone (925) 924-1600

Other identifiers 1

IdentifierTypeStateIssuer
CA2112OtherILMEDICARE RR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1730138496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 634717",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630001",
            "telephone_number": "925-924-1600",
            "fax_number": "925-924-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MAPLE RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604321439",
            "telephone_number": "925-924-1600",
            "fax_number": "925-924-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FISCHER MANGOLD/JOLIET",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "CARVOLTH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-924-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CA2112",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; 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.