NPIMap

Organization Active NPI

Adventist Midwest Health

  • Cardiovascular Disease Physician
  • La Grange, IL
National Provider Identifier
1821156068
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
ADVENTIST MIDWEST HEALTH
Practice address
5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone
(708) 245-3650
NPI assigned
Dec 4, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mrs. Ruby Mann
Title
Director of Managed Care
Phone
(630) 856-6884

Other NPIs on the same Medicare enrollment 1

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

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 44

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040427000900 IL Part B Supplier - Clinic/Group Practice 8224025887 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
Practice locations: La Grange, IL; Westchester, IL; Lagrange, IL

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

NPPES NPI Registry

Primary practice location

5101 Willow Springs Rd
La Grange, IL 60525-2600

Mailing address

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-3650

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
CG5784OtherILRAILROAD MEDICARE PTAN

Other names 1

NPPES NPI Registry
  • LAGRANGE MEMORIAL HOSPITAL CARDIOLOLGY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 21, 2016.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1821156068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 WILLOW SPRINGS RD",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252600",
            "telephone_number": "708-245-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 WILLOW SPRINGS RD",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252600",
            "telephone_number": "708-245-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST MIDWEST HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "630-856-6884",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "CG5784",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAGRANGE MEMORIAL HOSPITAL CARDIOLOLGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Grange, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.