NPIMap

Organization Active NPI

Enterprise Surgical Assistance

  • Surgical Physician Assistant
  • Berwyn, IL
National Provider Identifier
1992910988
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
ENTERPRISE SURGICAL ASSISTANCE
Practice address
3249 Oak Park Ave
Berwyn, IL 60402-3429
Phone
(708) 783-7696
Fax
(773) 404-2086
NPI assigned
May 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Authorized official

Name
Dr. Randall David Ostroff, M.D.
Title
President
Phone
(773) 502-4221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AS0400X Primary

Addresses

Primary practice location

3249 Oak Park Ave
Berwyn, IL 60402-3429

Mailing address

PO Box 56341
Chicago, IL 60656-0341
Phone (708) 867-4949

Other identifiers 1

IdentifierTypeStateIssuer
01637103OtherILBLUE CROSS BLUE SHIELD OF IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1992910988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 56341",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606560341",
            "telephone_number": "708-867-4949",
            "fax_number": "708-867-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3249 OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023429",
            "telephone_number": "708-783-7696",
            "fax_number": "773-404-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTERPRISE SURGICAL ASSISTANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "OSTROFF",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-502-4221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF IL",
            "identifier": "01637103",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; 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.