NPIMap

Organization Active NPI

Novamed Surgery Center of Chicago-Northshore, LLC

  • Ambulatory Surgical Clinic/Center
  • Chicago, IL
National Provider Identifier
1992709851
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
7002678 Issued in IL
Legal business name
NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC
Practice address
3034 W Peterson Ave
Chicago, IL 60659-3729
Phone
(773) 973-7432
Fax
(773) 973-1119
NPI assigned
Jun 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 7002678 IL Primary

Addresses

Primary practice location

3034 W Peterson Ave
Chicago, IL 60659-3729

Mailing address

3034 W Peterson Ave
Chicago, IL 60659-3729
Phone (773) 973-7432

Other identifiers 2

IdentifierTypeStateIssuer
P00012000OtherRR MEDICARE
326488082001MedicaidIL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Novamed Surgery Center of Chicago Northshore LLCCCN 14C0001033
Medicare certification status
Terminated Voluntary: merger or closure, Aug 1, 2025From the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

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

Locations

3034 W Peterson Ave
Chicago, IL 60659
Phone (773) 973-7432

867027 Reliable Pkwy
Chicago, IL 60686

Practitioners & affiliated clinicians

Practitioners 4

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": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1992709851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3034 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593729",
            "telephone_number": "773-973-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3034 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593729",
            "telephone_number": "773-973-7432",
            "fax_number": "773-973-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5900"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00012000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "326488082001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.