NPIMap

Organization Active NPI

Maxwell Medical Group, SC

  • Multi-Specialty Clinic/Center
  • Northbrook, IL
National Provider Identifier
1790448512
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MAXWELL MEDICAL GROUP, SC
Practice address
1901 Raymond Dr.
Suite 5
Northbrook, IL 60062
Phone
(855) 629-8353
NPI assigned
Oct 19, 2021
Last updated
Jan 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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

Authorized official

Name
Andrew Rosenson, MDNPI 1942208079
Title
President
Phone
(847) 814-9955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Multi-Specialty Clinic/Center 261QM1300X Primary
Mobile Radiology Clinic/Center 261QR0208X
Diagnostic Ultrasound Physician 2085U0001X

Addresses

Primary practice location

1901 Raymond Dr.
Suite 5
Northbrook, IL 60062

Mailing address

4336 West Enfield
Skokie, IL 60076

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220210000337 IL Part B Supplier - Clinic/Group Practice 0941693170 Receives reassigned benefits from 3 practitioners
Practice locations: Northbrook, IL

National Provider Directory

National Provider Directory

Locations

1901 Raymond Dr
Northbrook, IL 60062

1901 Raymond Dr
Ste 5
Northbrook, IL 60062
Phone (855) 629-8353

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1790448512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4336 WEST ENFIELD",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "60076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 RAYMOND DR.",
            "address_2": "SUITE 5",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "60062",
            "telephone_number": "855-629-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXWELL MEDICAL GROUP, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-19",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "ROSENSON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-814-9955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.