NPIMap

Organization Active NPI

Northern Illinois Medical Group S. C.

  • Family Medicine Physician
  • Rockford, IL
National Provider Identifier
1861670101
Registry record updated Oct 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHERN ILLINOIS MEDICAL GROUP S. C.
Practice address
5301 E State St Ste 101
Rockford, IL 61108-2388
Phone
(815) 397-8500
Fax
(815) 397-8588
NPI assigned
Feb 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2013

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

Authorized official

Name
Dr. Andrew Kong, D.C.
Title
Owner
Phone
(815) 397-8500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X IL
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X IL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X IL Primary

Addresses

Primary practice location

5301 E State St Ste 101
Rockford, IL 61108-2388

Mailing address

5301 E State St Ste 101
Rockford, IL 61108-2388
Phone (815) 397-8500

National Provider Directory

National Provider Directory

Locations

5301 E State St
Ste 101
Rockford, IL 61108
Phone (815) 397-8500

Practitioners & affiliated clinicians

Practitioners 10

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": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382918400000",
    "number": "1861670101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 E STATE ST STE 101",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082388",
            "telephone_number": "815-397-8500",
            "fax_number": "815-397-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E STATE ST STE 101",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082388",
            "telephone_number": "815-397-8500",
            "fax_number": "815-397-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS MEDICAL GROUP S. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2013-10-28",
        "status": "A",
        "authorized_official_last_name": "KONG",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-397-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.