NPIMap

Organization Active NPI

Dupage Medical Group, LTD.

Doing business as DuPage Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Wheaton, IL
National Provider Identifier
1891174660
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
042000124 Issued in IL
Legal business name
DUPAGE MEDICAL GROUP, LTD.
Doing business as
DuPage Medical Group
Practice address
150 E Willow Ave
Suite 110
Wheaton, IL 60187-5476
Phone
(630) 967-2000
Fax
(630) 653-3581
NPI assigned
May 26, 2015
Organization subpart
Yes
Parent organization
DUPAGE MEDICAL GROUP, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Authorized official

Name
Paul Merrick, MD
Title
Chairman of the Board
Phone
(630) 790-1221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 042000124 IL Primary

Addresses

Primary practice location

150 E Willow Ave
Suite 110
Wheaton, IL 60187-5476

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Other identifiers 2

IdentifierTypeStateIssuer
205994OtherILMEDICARE GROUP PTAN
785110OtherILMEDICARE GROUP PTAN

Other names 1

  • DuPage Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160126000097 IL DME Supplier - Physician - Physical and Rehabilitation 5496667941 Practice locations: Wheaton, IL

National Provider Directory

National Provider Directory
Tax ID family
Glen Ellyn Clinic SC la35 organizations share this tax ID, including this one
Part of
Glen Ellyn Clinic SC la

Other organizations with this tax ID 34

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

View all 34

Locations

150 E Willow Ave
Ste 110
Wheaton, IL 60187
Phone (630) 545-6016

NPI Registry JSON

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1891174660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E WILLOW AVE",
            "address_2": "SUITE 110",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601875476",
            "telephone_number": "630-967-2000",
            "fax_number": "630-653-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUPAGE MEDICAL GROUP, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DUPAGE MEDICAL GROUP, LTD",
        "enumeration_date": "2015-05-26",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "MERRICK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "630-790-1221",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "042000124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "205994",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "785110",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DuPage Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DuPage Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; 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.