NPIMap

Organization Active NPI

Good Samaritan Pontiac

  • Skilled Nursing Facility
  • Pontiac, IL
National Provider Identifier
1881679579
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1630299 Issued in IL
Legal business name
GOOD SAMARITAN PONTIAC
Practice address
1225 S Ewing Dr
Pontiac, IL 61764-9701
Phone
(815) 844-5121
Fax
(815) 419-6000
NPI assigned
Dec 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Kim Wittenberg, RN
Title
Administrator
Phone
(815) 844-5121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 1630299 IL
Skilled Nursing Facility 314000000X 1630299 IL Primary

Addresses

Primary practice location

1225 S Ewing Dr
Pontiac, IL 61764-9701

Mailing address

1225 S Ewing Dr
Pontiac, IL 61764-9701
Phone (815) 844-5121

Other identifiers 1

IdentifierTypeStateIssuer
0010942MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Livingston Co Public HLTH Dept10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14335 US Highway 66
Pontiac, IL 61764
Phone (815) 844-5121

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1881679579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 S EWING DR",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649701",
            "telephone_number": "815-844-5121",
            "fax_number": "815-419-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 S EWING DR",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649701",
            "telephone_number": "815-844-5121",
            "fax_number": "815-419-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN PONTIAC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "WITTENBERG",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-844-5121",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "1630299",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "1630299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010942",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.