NPIMap

Organization Active NPI

Northern Illinois Home Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Dixon, IL
National Provider Identifier
1962497735
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
NORTHERN ILLINOIS HOME MEDICAL SUPPLY
Practice address
1309 N Galena Ave
Dixon, IL 61021-1060
Phone
(815) 285-5857
Fax
(815) 285-5858
NPI assigned
Sep 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Robert Lesage
Title
President
Phone
(815) 284-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X IL Primary

Addresses

Primary practice location

1309 N Galena Ave
Dixon, IL 61021-1060

Mailing address

1309 N Galena Ave
Dixon, IL 61021-1060
Phone (815) 285-5857

Other identifiers 2

IdentifierTypeStateIssuer
072724OtherHEALTH ALLIANCE MED PLANS
09832001OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930024218 IL DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Oxygen & Equipment 1658583018 Practice locations: Dixon, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Northern Illinois Home Medical Supp1309 N Galena Ave, Dixon, IL 61021-1060(815) 285-5857 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Ultraviolet Light Devices and/or Supplies|Canes and/or Crutches|Patient Lifts|Power Operated Vehicles (Scoot… Does not accept assignmentParticipating since Feb 5, 2002

National Provider Directory

National Provider Directory
Tax ID family
Northern Illinois Home Medical Supply2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962497735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 N GALENA AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211060",
            "telephone_number": "815-285-5857",
            "fax_number": "815-285-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 N GALENA AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211060",
            "telephone_number": "815-285-5857",
            "fax_number": "815-285-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS HOME MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LESAGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-284-8200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE MED PLANS",
            "identifier": "072724",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "09832001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.