Individual provider Active NPI

Jonathan Huang, M.D.

  • Internal Medicine Physician
  • Crystal Lake, IL
National Provider Identifier
1922374024
Registry record updated Oct 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036136651 Issued in IL
Practice address
650 Dakota St
Suite a
Crystal Lake, IL 60012-3744
Phone
(815) 455-6000
Fax
(815) 356-3914
NPI assigned
Mar 23, 2012
Last updated
Oct 9, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57.021303 OH
Internal Medicine Physician 207R00000X DR.0058523 CO
Internal Medicine Physician 207R00000X 036136651 IL Primary

Addresses

Primary practice location

650 Dakota St
Suite a
Crystal Lake, IL 60012-3744

Mailing address

650 Dakota St
Suite a
Crystal Lake, IL 60012-3744
Phone (815) 455-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170623000741 CO Practitioner - Internal Medicine 6901047646 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
57.021303OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Nov 6, 2017 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Nov 6, 2017 Accepting new patients

Locations

175 S Union Blvd
Ste 350
Colorado Springs, CO 80910
Phone (719) 633-5515

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507507200000",
    "number": "1922374024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST",
            "address_2": "SUITE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123744",
            "telephone_number": "815-455-6000",
            "fax_number": "815-356-3914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 DAKOTA ST",
            "address_2": "SUITE A",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123744",
            "telephone_number": "815-455-6000",
            "fax_number": "815-356-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUANG",
        "first_name": "JONATHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-23",
        "last_updated": "2017-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "57.021303",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0058523",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036136651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.