NPIMap

Organization Active NPI

Fullerton Occupational Medicine & Immediate Care SC

  • Occupational Medicine Clinic/Center
  • Chicago, IL
National Provider Identifier
1740304757
Registry record updated Apr 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
License
364061160 Issued in IL
Legal business name
FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC
Practice address
3409 W Fullerton Ave
Chicago, IL 60647-2415
Phone
(773) 486-5001
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2010

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

Authorized official

Name
Renlin Xia, MD
Title
President
Phone
(773) 486-5001

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 364061160 IL
Urgent Care Clinic/Center 261QU0200X 364061160 IL
Occupational Medicine Clinic/Center 261QX0100X 364061160 IL Primary

Addresses

Primary practice location

3409 W Fullerton Ave
Chicago, IL 60647-2415

Mailing address

3409 W Fullerton Ave
Chicago, IL 60647-2415
Phone (773) 486-5001

Other identifiers 2

IdentifierTypeStateIssuer
036088691 4MedicaidIL
01635426OtherILOTHER

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271116800000",
    "number": "1740304757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472415",
            "telephone_number": "773-486-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472415",
            "telephone_number": "773-486-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2010-04-13",
        "status": "A",
        "authorized_official_last_name": "XIA",
        "authorized_official_first_name": "RENLIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-486-5001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "364061160",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "IL",
            "license": "364061160",
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "IL",
            "license": "364061160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088691 4",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "01635426",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; 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.