Medical Resource Center LTD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

036067911 Issued in IL

Legal business name

MEDICAL RESOURCE CENTER LTD

Practice address

6550 E Riverside Blvd
Loves Park, IL 61111-4424

Phone

(815) 633-4100

Fax

(815) 633-5141

NPI assigned

Jul 27, 2006

Last updated

Feb 13, 2024By 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

Dr. Steven J Disanti, D.O.NPI 1578582474

Title

Officer

Phone

(815) 633-4100

Specialties & licenses 3

Addresses

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

Practitioners 1

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.

• Steven J Disanti, DO

  • General Practice Physician
  • Genoa, IL
  • NPI 1578582474
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1770507295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 E RIVERSIDE BLVD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611114424",
            "telephone_number": "815-633-4100",
            "fax_number": "815-633-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 E RIVERSIDE BLVD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611114424",
            "telephone_number": "815-633-4100",
            "fax_number": "815-633-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL RESOURCE CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "DISANTI",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "815-633-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036096167",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036067911",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036066772",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Loves Park, IL
• Providers in Loves Park, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.