Eastside Healthcare of Chicago Heights SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EASTSIDE HEALTHCARE OF CHICAGO HEIGHTS SC

Practice address

2555 Lincoln Hwy
Suite 206
Olympia Fields, IL 60461-1936

Phone

(708) 757-3383

Fax

(708) 757-3386

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert C Watkins Jr, MD

Title

President

Phone

(708) 757-3383

Specialties & licenses 1

Addresses

Other identifiers 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15504/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481328000000",
    "number": "1922119072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 LINCOLN HWY",
            "address_2": "SUITE 206",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611936",
            "telephone_number": "708-757-3383",
            "fax_number": "708-757-3386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 LINCOLN HWY",
            "address_2": "SUITE 206",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611936",
            "telephone_number": "708-757-3383",
            "fax_number": "708-757-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE HEALTHCARE OF CHICAGO HEIGHTS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-12-10",
        "status": "A",
        "authorized_official_last_name": "WATKINS JR",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-757-3383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036045969",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annamaria Durante
• Sandra F Durley, PHARM D
• Arcot Dwarakanathan, M.D.,F.A.C.E.
• Brian Randolph Dyson, DO
• Earlesian Health Concepts
• Eddi Care LLC
• Eddi Care LLC
• Kayla Imani Eding, LCSW
• Edward J Pavlik DDS & Assoc LTD
• Ashley Shene Edwards, LCPC

• Family Medicine Physician in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2016; 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.