Premier Suburban Medical Group, PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PREMIER SUBURBAN MEDICAL GROUP, PLLC

Practice address

17047 La Grange Rd.
Orland Park, IL 60487-1913

Phone

(815) 300-7664

NPI assigned

Sep 16, 2020

Last updated

May 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Owens

Title

Director, Finance

Phone

(815) 300-7764

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 58

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.

• Refat Baridi, MD

  • Hematology & Oncology Physician
  • Woodridge, IL
  • NPI 1285622621
  Medicare reassignment Care Compare group NPD
• Arnold Garcia Bolisay, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Orland Park, IL
  • NPI 1891758512
  Medicare reassignment Care Compare group NPD
• Mary Anne Damiani, D.O.

  • Internal Medicine Physician
  • Woodridge, IL
  • NPI 1174578934
  Medicare reassignment Care Compare group NPD
• Ashok Gananath Dholakia, MD

  • Internal Medicine Physician
  • Woodridge, IL
  • NPI 1568451490
  Medicare reassignment Care Compare group NPD
• Joseph Michael Lach, DO

  • Family Medicine Physician
  • Joliet, IL
  • NPI 1225379498
  Medicare reassignment Care Compare group NPD
• Kaihua Lai, M.D.

  • Internal Medicine Physician
  • Naperville, IL
  • NPI 1689649659
  Medicare reassignment Care Compare group NPD
• Robert S Markus, MD

  • Orthopaedic Surgery Physician
  • Orland Park, IL
  • NPI 1588629026
  Medicare reassignment Care Compare group NPD
• Nancy Christine Melde, CNP

  • Nurse Practitioner
  • Palos Heights, IL
  • NPI 1487606208
  Medicare reassignment Care Compare group NPD
• Firouzeh Naghdi, DO

  • Family Medicine Physician
  • Woodridge, IL
  • NPI 1568426849
  Medicare reassignment Care Compare group NPD
• Robert J Oliver, MD

  • Pediatrics Physician
  • Woodridge, IL
  • NPI 1114981032
  Medicare reassignment Care Compare group NPD
• Jessica L Pecho, PA-C

  • Physician Assistant
  • New Lenox, IL
  • NPI 1528627239
  Medicare reassignment Care Compare group NPD
• Yogesh Tejpal, MD

  • Cardiovascular Disease Physician
  • Woodridge, IL
  • NPI 1730143017
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1902412950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17047 LA GRANGE RD.",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604871913",
            "telephone_number": "815-300-7664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Silver Cross Blvd",
            "address_purpose": "LOCATION",
            "city": "New Lenox",
            "state": "IL",
            "postal_code": "604519509",
            "country_code": "US",
            "telephone_number": "815-300-7106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER SUBURBAN MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, FINANCE",
        "authorized_official_telephone_number": "815-300-7764"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.