Organization Active NPI

Consultants in Laboratory Medicine and Pathology, LTD.

  • Anatomic Pathology & Clinical Pathology Physician
  • Evergreen Park, IL
National Provider Identifier
1861554602
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
CONSULTANTS IN LABORATORY MEDICINE AND PATHOLOGY, LTD.
Practice address
2800 W 95TH St
Dept of Pathology
Evergreen Park, IL 60805-2701
Phone
(708) 228-2875
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Authorized official

Name
Mary Therese Uckerman, MDNPI 1801809322
Title
Owner
Phone
(708) 229-5813

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X IL Primary

Addresses

Primary practice location

2800 W 95TH St
Dept of Pathology
Evergreen Park, IL 60805-2701

Mailing address

PO Box 5981
Carol Stream, IL 60197-5981

Other identifiers 1

IdentifierTypeStateIssuer
036083197MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080507000075 IL Part B Supplier - Clinic/Group Practice 4688753395 Receives reassigned benefits from 5 practitioners
Practice locations: Evergreen Park, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1861554602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5981",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601975981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 W 95TH ST",
            "address_2": "DEPT OF PATHOLOGY",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052701",
            "telephone_number": "708-228-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSULTANTS IN LABORATORY MEDICINE AND PATHOLOGY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "UCKERMAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "THERESE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-229-5813",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083197",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.