NPIMap

Organization Active NPI

Rush-Copley Medical Group

  • Gastroenterology Physician
  • Yorkville, IL
National Provider Identifier
1841579893
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036073955 Issued in IL
Legal business name
RUSH-COPLEY MEDICAL GROUP
Practice address
1100 W Veterans Pkwy
Suite 200
Yorkville, IL 60560-4728
Phone
(630) 820-4040
Fax
(630) 978-1240
NPI assigned
Aug 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Authorized official

Name
Marcee A Brummel
Title
Executive Director
Phone
(630) 978-4915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 036073955 IL
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X 036073955 IL Primary

Addresses

Primary practice location

1100 W Veterans Pkwy
Suite 200
Yorkville, IL 60560-4728

Mailing address

1256 Waterford Dr Ste 230
Aurora, IL 60504-4511
Phone (630) 499-2404

Other identifiers 1

IdentifierTypeStateIssuer
036073955MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310001029 IL Part B Supplier - Clinic/Group Practice 7618864877 Receives reassigned benefits from 188 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aurora, IL; Naperville, IL; North Aurora, IL; Oswego, IL; Plainfield, IL; Sugar Grove, IL; Yorkville, IL

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Locations

1901 W Galena Blvd
Aurora, IL 60506
Phone (630) 692-5960

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1841579893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 WATERFORD DR STE 230",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044511",
            "telephone_number": "630-499-2404",
            "fax_number": "630-692-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W VETERANS PKWY",
            "address_2": "SUITE 200",
            "city": "YORKVILLE",
            "state": "IL",
            "postal_code": "605604728",
            "telephone_number": "630-820-4040",
            "fax_number": "630-978-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSH-COPLEY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "BRUMMEL",
        "authorized_official_first_name": "MARCEE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-978-4915"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036073955",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036073955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073955",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yorkville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.