Dupage Urology Associates, LTD.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036-066425 Issued in IL

Legal business name

DUPAGE UROLOGY ASSOCIATES, LTD.

Practice address

1259 Rickert Drive
Suite 200
Naperville, IL 60540-8904

Phone

(630) 369-1572

Fax

(630) 369-6139

NPI assigned

Aug 15, 2006

Last updated

Dec 12, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Michael Bockrath, M.D.NPI 1992754493

Title

President

Phone

(630) 369-1572

Specialties & licenses 5

Addresses

Other identifiers 5

Locations

Practitioners 3

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.

• John M Bockrath, MD

  • Urology Physician
  • Naperville, IL
  • NPI 1992754493
  Authorized official Same address or phone
• Paul B Lyon, MD

  • Urology Physician
  • Naperville, IL
  • NPI 1194773465
  NPD (past)
• Misty Wessing, PA-C

  • Surgical Physician Assistant
  • Naperville, IL
  • NPI 1255341681
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229040000000",
    "number": "1861405177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1259 RICKERT DRIVE",
            "address_2": "SUITE 200",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605408904",
            "telephone_number": "630-369-1572",
            "fax_number": "630-369-6139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 RICKERT DRIVE",
            "address_2": "SUITE 200",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605408904",
            "telephone_number": "630-369-1572",
            "fax_number": "630-369-6139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUPAGE UROLOGY ASSOCIATES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2008-12-12",
        "status": "A",
        "authorized_official_last_name": "BOCKRATH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-369-1572",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-054923",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-066425",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-090448",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-099752",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-090506",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-090506",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-066425",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-099752",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-054923",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-090448",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Naperville, IL
• Providers in Naperville, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; 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.