Organization Active NPI

Heartland Primary Care SC

  • Internal Medicine Physician
  • Bolingbrook, IL
National Provider Identifier
1871715227
Registry record updated Dec 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
336-071828 Issued in IL
Legal business name
HEARTLAND PRIMARY CARE SC
Practice address
215 Remington Blvd
Suite F
Bolingbrook, IL 60440-3662
Phone
(630) 378-4880
Fax
(630) 378-4481
NPI assigned
May 3, 2007
Last updated
Dec 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2014

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

Authorized official

Name
Srilakshmi Vemareddy, M.DNPI 1215922398
Title
Physician
Phone
(630) 854-3235

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
Internal Medicine Physician 207R00000X 336-071828 IL Primary

Addresses

Primary practice location

215 Remington Blvd
Suite F
Bolingbrook, IL 60440-3662

Mailing address

215 Remington Blvd
Suite F
Bolingbrook, IL 60440-3656
Phone (630) 378-4880

Other identifiers 1

IdentifierTypeStateIssuer
036109580OtherILLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070530000043 IL Part B Supplier - Clinic/Group Practice 9830296797 Receives reassigned benefits from 2 practitioners
Practice locations: Bolingbrook, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1069010Heartland Primary Care S C215 Remington Blvd, Suite F, Bolingbrook, IL 60440Certificate of waiverMay 24, 2027

National Provider Directory

National Provider Directory

Locations

215 Remington Blvd
Ste F
Bolingbrook, IL 60440
Phone (630) 378-4480

420 N Schmidt Rd
Ste 210
Bolingbrook, IL 60440
Phone (630) 854-3235

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419984000000",
    "number": "1871715227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 REMINGTON BLVD",
            "address_2": "SUITE F",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403656",
            "telephone_number": "630-378-4880",
            "fax_number": "630-378-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 REMINGTON BLVD",
            "address_2": "SUITE F",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403662",
            "telephone_number": "630-378-4880",
            "fax_number": "630-378-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PRIMARY CARE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2014-12-31",
        "status": "A",
        "authorized_official_last_name": "VEMAREDDY",
        "authorized_official_first_name": "SRILAKSHMI",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "630-854-3235",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "336-071828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036109580",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.