North Suburban Family Physicians SC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

036105977 Issued in IL

Legal business name

NORTH SUBURBAN FAMILY PHYSICIANS SC

Doing business as

North Suburban Family Physicians

Practice address

1256 American Way
Libertyville, IL 60048-3936

Phone

(224) 424-4624

Fax

(224) 424-4631

NPI assigned

Apr 29, 2016

Last updated

Feb 12, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas Michael McGowan, MDNPI 1033173893

Title

Owner

Phone

(224) 424-4624

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• North Suburban Family Physicians Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Thomas Michael McGowan, M.D.

  • Family Medicine Physician
  • Lindenhurst, IL
  • NPI 1033173893
  Medicare reassignment NPD Authorized official
• Daniela Cvetkova, PA

  • Physician Assistant
  • Lake Forest, IL
  • NPI 1548534977
  Medicare reassignment
• Scott Richard Heelan, PA-C

  • Physician Assistant
  • Libertyville, IL
  • NPI 1194201947
  Medicare reassignment
• Emily Horecny, APRN

  • Family Nurse Practitioner
  • Libertyville, IL
  • NPI 1609539352
  NPD
• Eric J Marsh, MD

  • Dermatology Physician
  • Kenosha, WI
  • NPI 1508853185
  NPD
• Sandi M Motisi, APN, FNP-C

  • Adult Health Nurse Practitioner
  • Barrington, IL
  • NPI 1821233149
  NPD (past)

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549929600000",
    "number": "1740635432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252-1256 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "224-424-4624",
            "fax_number": "224-424-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1256 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "224-424-4624",
            "fax_number": "224-424-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUBURBAN FAMILY PHYSICIANS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2019-02-12",
        "status": "A",
        "authorized_official_last_name": "MCGOWAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-424-4624",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036105977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036105977",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Suburban Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Suburban Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; 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.