NPIMap

Organization Active NPI

Parkside Obstetrics & Gynecology SC

  • Obstetrics & Gynecology Physician
  • Park Ridge, IL
National Provider Identifier
1962491472
Registry record updated Dec 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
PARKSIDE OBSTETRICS & GYNECOLOGY SC
Practice address
1875 Dempster St
Suite 465
Park Ridge, IL 60068-1186
Phone
(847) 825-1100
Fax
(847) 825-0994
NPI assigned
Oct 18, 2005
Last updated
Dec 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2019

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

Authorized official

Name
Robert G. Koss, MDNPI 1821078759
Title
President
Phone
(847) 825-1100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1875 Dempster St
Suite 465
Park Ridge, IL 60068-1186

Mailing address

1875 Dempster St
Suite 465
Park Ridge, IL 60068-1186
Phone (847) 825-1100

Other names 1

  • Parkside Obstetrics Gynceology & Infertility SC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575417600000",
    "number": "1962491472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 465",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-825-1100",
            "fax_number": "847-825-0994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 465",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-825-1100",
            "fax_number": "847-825-0994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE OBSTETRICS & GYNECOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2019-12-04",
        "status": "A",
        "authorized_official_last_name": "KOSS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-825-1100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Obstetrics Gynceology & Infertility SC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; 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.