Boulevard Medical Associates, SC

Primary specialty

Legal MedicineTaxonomy code 173000000X

Legal business name

BOULEVARD MEDICAL ASSOCIATES, SC

Practice address

30 E 15TH St
Suite 202
Chicago Heights, IL 60411-3459

Phone

(708) 754-7777

Fax

(708) 754-7701

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Savio Manatt, M.D.NPI 1063585032

Title

President

Phone

(708) 754-7777

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Savio G Manatt, M.D.

  • Internal Medicine Physician
  • Olympia Fields, IL
  • NPI 1063585032

  Legal Medicine

  NPD (past) Authorized official

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982752911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E 15TH ST",
            "address_2": "SUITE 202",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113459",
            "telephone_number": "708-754-7777",
            "fax_number": "708-754-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E 15TH ST",
            "address_2": "SUITE 202",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113459",
            "telephone_number": "708-754-7777",
            "fax_number": "708-754-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD MEDICAL ASSOCIATES, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANATT",
        "authorized_official_first_name": "SAVIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-754-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01623866",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Billies House
• Terrill Binion
• Bloom Township School District 206
• Joseph P Bonanno, D.O.
• Gail D Bonds Carpenter
• Boulevard Pediatrics SC
• Roshana Bowens
• Latrice Boyd
• Thomas Boyle, D.O.
• George Brassea III, LCPC

• Legal Medicine in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Legal Medicine in Illinois

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.