The Board of Trustees of the University of Illinois
Organization Active NPI Pediatrics Physician · Rockford, IL
NPI 1972541902 · NPPES record last updated Aug 18, 2022
Key facts
- NPI
- 1972541902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
- Practice address
- 2350 N Rockton Ave Ste 204
Rockford, IL 61103-3669 - Phone
- (815) 395-8812
- NPI assigned
- Jun 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Loreen Sue Didier
- Title
- Credentialing Specialist
- Phone
- (815) 395-5861
Other NPIs on the same Medicare enrollment 44
Corporate family (same tax ID) 15
Practitioners 38
-
Alvydas J Baris, MD
-
Olesya Brandis, MD
-
Andrzej M Dudas, D.O.
-
Carole J Eatock, CNP
-
Sherry A Falsetti, PHD
-
Tsai Ling Liao, MD
-
Vasil Nika, M.D.
-
Jeffrey S Royce, MD
-
Lee Sesslar, MD
-
Christine L. Valentine, APRN, CNP
-
Agnieszka Tyl, PA-A
-
Peggy L Bandy, M.D.
-
Brian Baranyi, PT, DPT, OCS
-
Grethel Bayro, MS, CCC-SLP
-
Susan Collazo, APRN, CNP
-
Therese Marie Doyle, CNM
-
Patricia Jaimes-Huerta, M.D.
-
Mitchell S King, MD
-
Jacqueline G May, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031112000158 | IL | Part B Supplier - Clinic/Group Practice | 3072422716 |
Receives reassigned benefits from 2,115 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Univ of Illinois Hospit
Locations
1801 W Taylor St
#4C
Chicago, IL 60612
Phone (312) 413-7500
7736 Solutions Ctr
Chicago, IL 60677
1640 W Roosevelt Rd
#336
Chicago, IL 60608
Phone (312) 355-4913
835 S Wolcott Ave
Rm E144
Chicago, IL 60612
Phone (312) 996-5804
840 S Wood St
Ste 130CSN
Chicago, IL 60612
845 S Damen Ave
Chicago, IL 60612
Phone (312) 996-0376
839 W 79th St
Chicago, IL 60620
Phone (312) 492-1220
405 Charles St
Mount Morris, IL 61054
Phone (815) 395-5860
900 Skokie Blvd
Ste 13
Northbrook, IL 60062
2350 N Rockton Ave
Ste 204
Rockford, IL 61103
Phone (815) 395-8812
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
2350 N Rockton Ave Ste 204
Rockford, IL 61103-3669
Mailing address
1601 Parkview Ave
Rockford, IL 61107-1822
Phone (815) 395-5861
Other names
- UIC MERIT
Other providers in Rockford, IL
- Vivek Thappa
- The Arc of Winnebago, Boone and Ogle Counties
- The Attachment Group
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Bridge Clinic of Rockofrd
- The Elitist Group
- The Fit Med Experience
- The Inspiration and Life Enhancement
- The Lotus Center
All providers in Rockford, IL · Pediatrics Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.