NPIMap

Organization Active NPI

Ear Nose & Throat Specialists of Rockford SC

  • Preferred Provider Organization
  • Rockford, IL
National Provider Identifier
1740491745
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
036067207 Issued in IL
Legal business name
EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC
Practice address
435 N Mulford Rd
Suite 10
Rockford, IL 61107-5189
Phone
(815) 399-5268
Fax
(815) 399-3623
NPI assigned
May 24, 2007
Last updated
Mar 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Dr. James Melvin Severson III, MDNPI 1518912765
Title
Medical Doctor
Phone
(815) 399-5268

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
Preferred Provider Organization 305R00000X 036067207 IL Primary

Addresses

Primary practice location

435 N Mulford Rd
Suite 10
Rockford, IL 61107-5189

Mailing address

435 N Mulford Rd
Suite 10
Rockford, IL 61107-5189
Phone (815) 399-5268

Other identifiers 1

IdentifierTypeStateIssuer
036067207MedicaidIL

Other names 1

  • James Melvin Severson Other name

National Provider Directory

National Provider Directory

Locations

435 N Mulford Rd
Rockford, IL 61107
Phone (815) 399-5268

Practitioners & affiliated clinicians

Practitioners 5

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": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1740491745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 N MULFORD RD",
            "address_2": "SUITE 10",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075189",
            "telephone_number": "815-399-5268",
            "fax_number": "815-399-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 N MULFORD RD",
            "address_2": "SUITE 10",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075189",
            "telephone_number": "815-399-5268",
            "fax_number": "815-399-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "SEVERSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MELVIN",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "815-399-5268",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "036067207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067207",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "James Melvin Severson",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.