NPIMap

Organization Active NPI

Andersontiernan Inc

  • Podiatrist
  • Schaumburg, IL
National Provider Identifier
1992091219
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016005321 Issued in IL
Legal business name
ANDERSONTIERNAN INC
Practice address
455 S Roselle Rd
Suite 100
Schaumburg, IL 60193-2971
Phone
(847) 985-8380
Fax
(847) 985-9475
NPI assigned
Jun 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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

Authorized official

Name
Dr. Breck Tiernan, DPM
Title
Co-President
Phone
(815) 553-0990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 016005321 IL Primary

Addresses

Primary practice location

455 S Roselle Rd
Suite 100
Schaumburg, IL 60193-2971

Mailing address

350 Houbolt Rd
Suite 104
Joliet, IL 60431-8305
Phone (815) 553-0990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121002000588 IL Part B Supplier - Clinic/Group Practice 6901055235 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL; Hoffman Estates, IL
O20151103002101 WI Part B Supplier - Clinic/Group Practice 6901055235 Receives reassigned benefits from 1 practitioner
Practice locations: Kenosha, WI

National Provider Directory

National Provider Directory
Tax ID family
Andersontiernan Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349308800000",
    "number": "1992091219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 HOUBOLT RD",
            "address_2": "SUITE 104",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604318305",
            "telephone_number": "815-553-0990",
            "fax_number": "815-553-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S ROSELLE RD",
            "address_2": "SUITE 100",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601932971",
            "telephone_number": "847-985-8380",
            "fax_number": "847-985-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSONTIERNAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-24",
        "last_updated": "2012-10-04",
        "status": "A",
        "authorized_official_last_name": "TIERNAN",
        "authorized_official_first_name": "BRECK",
        "authorized_official_title_or_position": "CO-PRESIDENT",
        "authorized_official_telephone_number": "815-553-0990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016005321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.