NPIMap

Organization Active NPI

Edgebrook Radiology Management

Doing business as Edgebrook Radiology

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Des Plaines, IL
National Provider Identifier
1821045659
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
EDGEBROOK RADIOLOGY MANAGEMENT
Doing business as
Edgebrook Radiology
Practice address
2410 S River Rd
Des Plaines, IL 60018-3201
Phone
(773) 774-6440
Fax
(773) 774-4372
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Mr. George Nellamathatil
Title
Director
Phone
(773) 774-6440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X IL Primary

Addresses

Primary practice location

2410 S River Rd
Des Plaines, IL 60018-3201

Mailing address

PO Box 7389
Prospect Heights, IL 60070-7389
Phone (847) 870-3600

Other names 1

  • EDGEBROOK RADIOLOGY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614001170 IL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3375587934 Practice locations: Des Plaines, IL

National Provider Directory

National Provider Directory
Tax ID family
Edgebrook Radiology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2410 S River Rd
Des Plaines, IL 60018
Phone (773) 774-6440

Practitioners & affiliated clinicians

Practitioners 2

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": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1821045659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7389",
            "city": "PROSPECT HEIGHTS",
            "state": "IL",
            "postal_code": "600707389",
            "telephone_number": "847-870-3600",
            "fax_number": "847-870-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 S RIVER RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600183201",
            "telephone_number": "773-774-6440",
            "fax_number": "773-774-4372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEBROOK RADIOLOGY MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "NELLAMATHATIL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-774-6440",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDGEBROOK RADIOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.