NPIMap

Organization Active NPI

Advocate Illinois Masonic Medical Center

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1780850404
Registry record updated Dec 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125053624 Issued in IL
Legal business name
ADVOCATE ILLINOIS MASONIC MEDICAL CENTER
Practice address
3048 N Wilton Ave
2ND Floor
Chicago, IL 60657-6710
Phone
(773) 296-5424
Fax
(773) 296-5280
NPI assigned
May 2, 2008
Last updated
Dec 5, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVOCATE HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 5, 2008

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

Authorized official

Name
Dr. Teresa Ramos
Title
Residency Program Director
Phone
(773) 296-7046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 125053624 IL Primary

Addresses

Primary practice location

3048 N Wilton Ave
2ND Floor
Chicago, IL 60657-6710

Mailing address

836 W Wellington Ave
Room 7403
Chicago, IL 60657-5147

National Provider Directory

National Provider Directory
Tax ID family
Advocate Family Practic22 organizations share this tax ID, including this one
Part of
Advocate Family Practic

Other organizations with this tax ID 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228435200000",
    "number": "1780850404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 W WELLINGTON AVE",
            "address_2": "ROOM 7403",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 N WILTON AVE",
            "address_2": "2ND FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576710",
            "telephone_number": "773-296-5424",
            "fax_number": "773-296-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATE ILLINOIS MASONIC MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVOCATE HEALTHCARE",
        "enumeration_date": "2008-05-02",
        "last_updated": "2008-12-05",
        "status": "A",
        "authorized_official_last_name": "RAMOS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "RESIDENCY PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "773-296-7046",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125053624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; 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.