NPIMap

Organization Active NPI

Midwest Physician Group LTD

  • Nurse Practitioner
  • Olympia Fields, IL
National Provider Identifier
1790976231
Registry record updated Aug 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MIDWEST PHYSICIAN GROUP LTD
Practice address
3800 W 203Rd St
Olympia Fields, IL 60461-1184
Phone
(708) 747-0461
Fax
(708) 747-0607
NPI assigned
Aug 8, 2007
Organization subpart
Yes
Parent organization
MIDWEST PHYSICIAN GROUP LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2007

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

Authorized official

Name
Deborah J Nelson
Title
Ceo
Phone
(708) 747-7960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X IL Primary

Addresses

Primary practice location

3800 W 203Rd St
Olympia Fields, IL 60461-1184

Mailing address

20110 Governors Hwy
Olympia Fields, IL 60461-1030
Phone (708) 747-7960

Other names 1

  • MARITTA A PENEGOR CFNP Other name

National Provider Directory

National Provider Directory
Tax ID family
Par Family Med Ctr3 organizations share this tax ID, including this one
Part of
Par Family Med Ctr

Other organizations with this tax ID 2

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": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186617600000",
    "number": "1790976231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20110 GOVERNORS HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611030",
            "telephone_number": "708-747-7960",
            "fax_number": "708-503-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W 203RD ST",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611184",
            "telephone_number": "708-747-0461",
            "fax_number": "708-747-0607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PHYSICIAN GROUP LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST PHYSICIAN GROUP LTD",
        "enumeration_date": "2007-08-08",
        "last_updated": "2007-08-09",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-747-7960"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARITTA A PENEGOR CFNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; 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.