Salud Pediatrics SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036101829 Issued in IL

Legal business name

SALUD PEDIATRICS SC

Practice address

600 S Randall Rd
Suite 220
Algonquin, IL 60102-5935

Phone

(847) 854-9402

Fax

(847) 854-9403

NPI assigned

Jul 13, 2006

Last updated

Apr 6, 2011By 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

Joanna E. Betancourt, M.D.NPI 1992703227

Title

Director

Phone

(847) 854-9402

Specialties & licenses 1

Addresses

Other identifiers 1

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

Locations

Practitioners 7

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.

• Joanna E Betancourt, MD

  • Pediatrics Physician
  • Algonquin, IL
  • NPI 1992703227
  NPD (past) Authorized official
• Marciann W Bock, APN

  • Nurse Practitioner
  • Algonquin, IL
  • NPI 1013188440
  NPD (past)
• Kelly Anne Gardynski, DNP, APRN, CPNP-PC

  • Pediatric Nurse Practitioner
  • Algonquin, IL
  • NPI 1720816382
  NPD (past)
• Sandra Lukic Graba, MD

  • Pediatrics Physician
  • Crystal Lake, IL
  • NPI 1477717213
  NPD (past)
• Sarah Zeigler Olsen, CPNP-PC

  • Pediatric Nurse Practitioner
  • Algonquin, IL
  • NPI 1740881291
  NPD (past)
• Richard Edward Powell, M.D.

  • Pediatrics Physician
  • Algonquin, IL
  • NPI 1043277148
  NPD (past)
• Mehgan Rickett, CPNP-PC

  • Pediatric Nurse Practitioner
  • Algonquin, IL
  • NPI 1841090610
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1801811757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S RANDALL RD",
            "address_2": "SUITE 220",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601025935",
            "telephone_number": "847-854-9402",
            "fax_number": "847-854-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S RANDALL RD",
            "address_2": "SUITE 220",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601025935",
            "telephone_number": "847-854-9402",
            "fax_number": "847-854-9403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALUD PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "BETANCOURT",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-854-9402",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036101829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "05632081",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen A Ryan Ceisel, PT
• Thomas R Sak, PSYD
• Irina Salabai
• Patricia Fernando Salazar, PT
• Timothy Salley, D.P.M.
• Johnathan Salvi
• Thomas Gerard Salvi, M.D.
• Natalia L Sanchez, COF
• Kevin Layton Sanderson
• Umapriya Sannapareddy, DDS

• Pediatrics Physician in Algonquin, IL
• Providers in Algonquin, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.