NPIMap

Organization Active NPI

Abc Pediatrics, LTD.

  • Pediatrics Physician
  • Naperville, IL
National Provider Identifier
1730201922
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
042.618674 Issued in IL
Legal business name
ABC PEDIATRICS, LTD.
Practice address
1331 W 75TH Street
Suite 300
Naperville, IL 60540
Phone
(630) 355-0003
Fax
(630) 355-9822
NPI assigned
Apr 6, 2007
Last updated
May 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Authorized official

Name
Dr. Gus A Rousonelos, M.D.NPI 1265410989
Title
Owner
Phone
(630) 355-0003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 042.618674 IL Primary

Addresses

Primary practice location

1331 W 75TH Street
Suite 300
Naperville, IL 60540

Mailing address

1331 W 75TH Street
Suite 300
Naperville, IL 60540
Phone (630) 355-0003

Other identifiers 3

IdentifierTypeStateIssuer
02201648OtherILBC BS PROVIDER NUMBER
14D0866815OtherCLIA WAIVER CERT
042.618674OtherILREGISTERED MEDICAL CORP

National Provider Directory

National Provider Directory

Locations

1331 W 75th St
Ste 300
Naperville, IL 60540
Phone (630) 355-0003

Practitioners & affiliated clinicians

Practitioners 7

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1730201922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 W 75TH STREET",
            "address_2": "SUITE 300",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "60540",
            "telephone_number": "630-355-0003",
            "fax_number": "630-355-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 W 75TH STREET",
            "address_2": "SUITE 300",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "60540",
            "telephone_number": "630-355-0003",
            "fax_number": "630-355-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC PEDIATRICS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "ROUSONELOS",
        "authorized_official_first_name": "GUS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-355-0003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "042.618674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS PROVIDER NUMBER",
            "identifier": "02201648",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVER CERT",
            "identifier": "14D0866815",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED MEDICAL CORP",
            "identifier": "042.618674",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; 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.