Southwest Medical Affiliates, PC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016004378 Issued in IL

Legal business name

SOUTHWEST MEDICAL AFFILIATES, PC

Practice address

5630 111TH St
Chicago Ridge, IL 60415-2406

Phone

(708) 857-5800

Fax

(708) 857-5805

NPI assigned

May 2, 2007

Organization subpart

No

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

Authorized official

Name

Sharon L Moriarty

Title

Financial Specialist

Phone

(708) 857-5804

Specialties & licenses 3

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353369600000",
    "number": "1760603054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5630 111TH ST",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152406",
            "telephone_number": "708-857-5800",
            "fax_number": "708-857-5805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5630 111TH ST",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152406",
            "telephone_number": "708-857-5800",
            "fax_number": "708-857-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MEDICAL AFFILIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2012-11-20",
        "status": "A",
        "authorized_official_last_name": "MORIARTY",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "FINANCIAL SPECIALIST",
        "authorized_official_telephone_number": "708-857-5804"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036063034",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036063793",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016004378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1407861982",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036063034",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1629084116",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972519486",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004378",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036063793",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Chicago Ridge, IL
• Providers in Chicago Ridge, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.