Greathouse Medical Group SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036114405 Issued in IL

Legal business name

GREATHOUSE MEDICAL GROUP SC

Practice address

1890 Silver Cross Blvd Ste 550
New Lenox, IL 60451-9579

Phone

(708) 264-8463

NPI assigned

May 4, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Deirdra Greathouse, MD

Title

President

Phone

(708) 264-8463

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Deirdra Greathouse-Williams, MD

  • Family Medicine Physician
  • New Lenox, IL
  • NPI 1871549238
  Medicare reassignment NPD

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1851827349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 DUNBAR ST",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604224380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 SILVER CROSS BLVD STE 550",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519579",
            "telephone_number": "708-264-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATHOUSE MEDICAL GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-04",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "GREATHOUSE",
        "authorized_official_first_name": "DEIRDRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-264-8463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036114405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julianne M. Goudzwaard, R.N. IBCLC
• Noah R Gould, DPT
• Nancy E Graben, OTR/L
• Marilyn Louise Graham, RPH
• Lori Granich, RDN
• Deirdra Greathouse-Williams, MD
• Melissa Gregory, LCPC
• Nicole M Gress, M.D.
• Dorothy Jean Griggs
• Emily Nancy Griggs

• Primary Care Clinic/Center in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.