Organization Active NPI

McHenry County Orthopaedics, S.C.

  • Orthopaedic Surgery Physician
  • Crystal Lake, IL
National Provider Identifier
1922292663
Registry record updated Dec 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
MCHENRY COUNTY ORTHOPAEDICS, S.C.
Practice address
420 N Il Route 31
Crystal Lake, IL 60012-3711
Phone
(815) 356-5200
Fax
(815) 356-5262
NPI assigned
Sep 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2014

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

Authorized official

Name
Ms. Manette Anne Decremer
Title
Administrator
Phone
(815) 788-2018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

420 N Il Route 31
Crystal Lake, IL 60012-3711

Mailing address

420 N Il Route 31
Crystal Lake, IL 60012-3711
Phone (815) 356-5200

Other identifiers 1

IdentifierTypeStateIssuer
5619608OtherILBLUE SHIELD GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

420 N State Route 31
Crystal Lake, IL 60012
Phone (815) 356-5200

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1922292663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 N IL ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123711",
            "telephone_number": "815-356-5200",
            "fax_number": "815-356-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N IL ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123711",
            "telephone_number": "815-356-5200",
            "fax_number": "815-356-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCHENRY COUNTY ORTHOPAEDICS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "DECREMER",
        "authorized_official_first_name": "MANETTE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-788-2018",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "5619608",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; 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.