NPIMap

Organization Active NPI

North Suburban Nephrology LLC

  • Specialist
  • Gurnee, IL
National Provider Identifier
1801041645
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
01553437 Issued in IL
Legal business name
NORTH SUBURBAN NEPHROLOGY LLC
Practice address
1425 N Hunt Club Rd Ste 301
Gurnee, IL 60031-2639
Phone
(847) 855-9252
Fax
(847) 855-5215
NPI assigned
Nov 20, 2008
Last updated
Apr 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Authorized official

Name
Dr. Walid N Ghantous, MDNPI 1780662254
Title
Ceo Member
Phone
(847) 446-3200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 01553437 IL Primary

Addresses

Primary practice location

1425 N Hunt Club Rd Ste 301
Gurnee, IL 60031-2639

Mailing address

120 W 22ND St Ste 200
Oak Brook, IL 60523-1563
Phone (630) 573-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090310000157 IL Part B Supplier - Clinic/Group Practice 5294891644 Receives reassigned benefits from 7 practitioners
Practice locations: Grayslake, IL; Gurnee, IL; Waukegan, IL

National Provider Directory

National Provider Directory

Locations

1445 N Hunt Club Rd
Ste 201
Gurnee, IL 60031
Phone (847) 673-1375

Practitioners & affiliated clinicians

Practitioners 10

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": "1227139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1801041645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 22ND ST STE 200",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231563",
            "telephone_number": "630-573-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 301",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312639",
            "telephone_number": "847-855-9252",
            "fax_number": "847-855-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUBURBAN NEPHROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-20",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "GHANTOUS",
        "authorized_official_first_name": "WALID",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO MEMBER",
        "authorized_official_telephone_number": "847-446-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "01553437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.