NPIMap

Organization Active NPI

Metro Infectious Disease Consultants LLC

  • Infectious Disease Physician
  • Normal, IL
National Provider Identifier
1811154354
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
00009202 Issued in IL
Legal business name
METRO INFECTIOUS DISEASE CONSULTANTS LLC
Practice address
1300 Franklin Avenue
Sutie 230C
Normal, IL 61761-3588
Phone
(888) 220-6432
NPI assigned
May 21, 2008
Last updated
Dec 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Authorized official

Name
Tara Kowalski
Title
Credentialing Manager
Phone
(888) 220-6432

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 00009202 IL Primary

Addresses

Primary practice location

1300 Franklin Avenue
Sutie 230C
Normal, IL 61761-3588

Mailing address

901 MC Clintock Drive
Suite 202
Burr Ridge, IL 60527-0844
Phone (888) 220-6432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000274 IL Part B Supplier - Clinic/Group Practice 3072425784 Receives reassigned benefits from 138 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2923 N California Ave
#220
Chicago, IL 60618
Phone (773) 205-4660

555 W Court St
Ste 108
Kankakee, IL 60901
Phone (815) 937-2015

5901 Dempster St
Ste 101
Morton Grove, IL 60053
Phone (847) 470-1115

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1811154354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MC CLINTOCK DRIVE",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270844",
            "telephone_number": "888-220-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 FRANKLIN AVENUE",
            "address_2": "SUTIE 230C",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613588",
            "telephone_number": "888-220-6432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO INFECTIOUS DISEASE CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "KOWALSKI",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "888-220-6432"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IL",
            "license": "00009202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; 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.