NPIMap

Organization Active NPI

PHC of Buffalo Grove Nutrition

Doing business as Portrait Health Centers

  • Registered Dietitian
  • Vernon Hills, IL
National Provider Identifier
1902107386
Registry record updated Sep 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
164005333 Issued in IL
Legal business name
PHC OF BUFFALO GROVE NUTRITION
Doing business as
Portrait Health Centers
Practice address
175 E Hawthorn Pkwy
Suite 235
Vernon Hills, IL 60061-1463
Phone
(847) 868-3435
Fax
(847) 859-5855
NPI assigned
Nov 16, 2010
Last updated
Sep 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2013

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

Authorized official

Name
Jeremy Warner
Title
Practice Manager
Phone
(847) 868-3435

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164005333 IL Primary

Addresses

Primary practice location

175 E Hawthorn Pkwy
Suite 235
Vernon Hills, IL 60061-1463

Mailing address

175 E Hawthorn Pkwy
Suite 235
Vernon Hills, IL 60061-1463
Phone (847) 868-3435

Other names 1

  • Portrait Health Centers Doing business as

National Provider Directory

National Provider Directory

Locations

111 Lions Dr
Ste 221
Barrington, IL 60010
Phone (847) 304-5849

1350 E Chicago St
Unit 17
Elgin, IL 60120

20550 S Lagrange Rd
Ste 105
Frankfort, IL 60423
Phone (708) 448-3300

997 N Corporate Cir
Grayslake, IL 60030
Phone (847) 223-8001

1689 N Curran Rd
Ste 202
McHenry, IL 60050

2100 18th Ave
Ste 130
Rock Island, IL 61201

1699 E Woodfield Rd
Ste 402
Schaumburg, IL 60173
Phone (253) 346-0133

2570 Foxfield Rd
Ste 107
St Charles, IL 60174
Phone (630) 853-3890

175 E Hawthorn Pkwy
Ste 23
Vernon Hills, IL 60061

175 E Hawthorne Pkwy
Ste 235
Vernon Hills, IL 60061
Phone (847) 865-4125

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1902107386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY",
            "address_2": "SUITE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611463",
            "telephone_number": "847-868-3435",
            "fax_number": "847-859-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY",
            "address_2": "SUITE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611463",
            "telephone_number": "847-868-3435",
            "fax_number": "847-859-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC OF BUFFALO GROVE NUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "847-868-3435"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164005333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portrait Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vernon Hills, IL

Sources for this page

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