NPIMap

Organization Active NPI

Presence Service Corporation

Doing business as Presence Medical Group

  • Family Medicine Physician
  • Bolingbrook, IL
National Provider Identifier
1831204536
Registry record updated Aug 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRESENCE SERVICE CORPORATION
Doing business as
Presence Medical Group
Practice address
1000 Remington Blvd
Suite 100
Bolingbrook, IL 60440-5114
Phone
(630) 914-2417
Fax
(630) 914-2499
NPI assigned
Aug 20, 2006
Last updated
Aug 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2013

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

Authorized official

Name
Melvonne Jones
Title
Credentialing Manager
Phone
(630) 914-2417

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Professional Counselor 101YP2500X NU
Psychologist 103T00000X NU
Allergy Physician 207KA0200X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Hematology & Oncology Physician 207RH0003X NU
Pulmonary Disease Physician 207RP1001X NU
Obstetrics & Gynecology Physician 207V00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Otolaryngology Physician 207Y00000X NU
Pediatrics Physician 208000000X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

1000 Remington Blvd
Suite 100
Bolingbrook, IL 60440-5114

Mailing address

9223 W Saint Francis Rd
Frankfort, IL 60423-8330
Phone (630) 914-2417

Other names 1

  • PRESENCE MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1300 N Highland Ave
Aurora, IL 60506
Phone (630) 301-7595

21 Heritage Dr
Ste 10
Bourbonnais, IL 60914
Phone (815) 937-8204

656 N Convent St
Ste A
Bourbonnais, IL 60914
Phone (815) 802-8031

25872 Network Pl
Chicago, IL 60673

75 Remittance Dr
Dept 1473
Chicago, IL 60675

540 W North St
Manhattan, IL 60442
Phone (815) 478-3890

305 N Vine St
New Lenox, IL 60451
Phone (805) 485-3802

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377216000000",
    "number": "1831204536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9223 W SAINT FRANCIS RD",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604238330",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BLVD",
            "address_2": "SUITE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604405114",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2013-08-23",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MELVONNE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "630-914-2417"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; 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.