Northern Illinois Plastic Surgery

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

NORTHERN ILLINOIS PLASTIC SURGERY

Practice address

5714 S Il Route 31
Suite a
Crystal Lake, IL 60014-4520

Phone

(815) 356-7000

Fax

(815) 356-7513

NPI assigned

Jun 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bradford C. Roberg, M.D.NPI 1316946072

Title

President

Phone

(847) 967-1149

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Bradford C Roberg, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Crystal Lake, IL
  • NPI 1316946072
  NPD (past) Authorized official

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831137520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8135 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607142828",
            "telephone_number": "847-967-1149",
            "fax_number": "847-967-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5714 S IL ROUTE 31",
            "address_2": "SUITE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600144520",
            "telephone_number": "815-356-7000",
            "fax_number": "815-356-7513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERG",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-967-1149",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ILLINOIS",
            "identifier": "00732007",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mistie E Norten-Hill, D.M.D.
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• Northern Illinois Home Care, LLC
• Northern Illinois Medical Center
• Northern Illinois Recovery LLC
• Northern Illinois Recovery LLC
• Northern Illinois Recovery LLC
• Christopher M Northern, PA
• Northland Hearing Centers, Inc.

• Plastic Surgery Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.