NPIMap

Organization Active NPI

Illinois Retina Associates, S.C.

  • Medical Specialty Clinic/Center
  • Harvey, IL
National Provider Identifier
1750765012
Registry record updated Nov 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
ILLINOIS RETINA ASSOCIATES, S.C.
Practice address
71 W 156TH St Ste 400
Harvey, IL 60426-4265
Phone
(708) 596-8710
NPI assigned
Jul 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2017

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

Authorized official

Name
Mary Frederick
Title
Billing Manager
Phone
(708) 915-6963

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Medical Specialty Clinic/Center 261QM2500X Primary
Ophthalmologic Surgery Clinic/Center 261QS0132X

Addresses

Primary practice location

71 W 156TH St Ste 400
Harvey, IL 60426-4265

Mailing address

71 W 156TH St Ste 400
Harvey, IL 60426-4265

National Provider Directory

National Provider Directory
Tax ID family
Illinois Retina Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1750765012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 W 156TH ST STE 400",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604264265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 W 156TH ST STE 400",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604264265",
            "telephone_number": "708-596-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS RETINA ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "708-915-6963"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvey, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; 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.