NPIMap

Organization Active NPI

Medsource LLC

  • Durable Medical Equipment & Medical Supplies
  • Des Plaines, IL
National Provider Identifier
1730354531
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
203.001082 Issued in IL
Legal business name
MEDSOURCE LLC
Practice address
200 Howard Ave Ste 206
Des Plaines, IL 60018-5907
Phone
(773) 265-7670
Fax
(773) 265-7674
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Authorized official

Name
Mr. Eric Rohde
Title
Owner
Phone
(309) 664-7930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 203.001082 IL Primary

Addresses

Primary practice location

200 Howard Ave Ste 206
Des Plaines, IL 60018-5907

Mailing address

PO Box 1248
Bloomington, IL 61702-1248
Phone (309) 664-7930

Other identifiers 1

IdentifierTypeStateIssuer
203.001082OtherILLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930059149 IL DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Orthotic Personnel 3072726967 Practice locations: Des Plaines, IL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Medsource LLC200 Howard Ave, Des Plaines, IL 60018-5907(773) 265-7670 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Osteogenesis Stimulators|Pneumatic Compression Devices and/or Sup… Accepts assignmentParticipating since Jan 1, 2008

National Provider Directory

National Provider Directory
Tax ID family
Medsource LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

700 N Sacramento Blvd
Ste 120
Chicago, IL 60612

200 Howard Ave
Ste 206
Des Plaines, IL 60018
Phone (773) 265-7670

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1730354531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1248",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617021248",
            "telephone_number": "309-664-7930",
            "fax_number": "309-664-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOWARD AVE STE 206",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600185907",
            "telephone_number": "773-265-7670",
            "fax_number": "773-265-7674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "ROHDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-664-7930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.001082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "203.001082",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.