Provider Demographics
NPI: | 1033149844 |
---|---|
Name: | CENTRAL DUPAGE PHYSICIAN GROUP |
Entity Type: | Organization |
Organization Name: | CENTRAL DUPAGE PHYSICIAN GROUP |
Other - Org Name: | NORTHWESTERN MEDICINE REGIONAL MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PREIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PATRICK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TOWNE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 630-933-1600 |
Mailing Address - Street 1: | 5777 DEPARTMENT |
Mailing Address - Street 2: | |
Mailing Address - City: | CAROL STREAM |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60122-5777 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 630-933-3300 |
Mailing Address - Fax: | 630-933-2740 |
Practice Address - Street 1: | 5777 DEPARTMENT |
Practice Address - Street 2: | |
Practice Address - City: | CAROL STREAM |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60122-5777 |
Practice Address - Country: | US |
Practice Address - Phone: | 630-933-3300 |
Practice Address - Fax: | 630-933-2740 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-04 |
Last Update Date: | 2021-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2083S0010X | Allopathic & Osteopathic Physicians | Preventive Medicine | Sports Medicine | Group - Multi-Specialty |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 080116892 | Other | MEDICARE RAILROAD MWB |
ID | 0222075 | Other | BLUE CROSS GROUP NUMBER |
ID | 0222075 | Other | BLUE CROSS GROUP NUMBER |
IL | ========= | Other | TAX IDENTIFICATION NUMBER |
IL | 920540 | Medicare ID - Type Unspecified | GROUP NUMBER |
IL | 208015 | Medicare PIN | |
IL | 206147 | Medicare ID - Type Unspecified | MEDICARE GROUP NUMBER |
IL | =========6019001 | Medicaid | |
IL | 367760 | Medicare ID - Type Unspecified | GROUP NUMBER |
ID | 0222075 | Other | BLUE CROSS GROUP NUMBER |
IL | 509110 | Medicare ID - Type Unspecified | GROUP NUMBER |
IL | 482450 | Medicare ID - Type Unspecified | GROUP NUMBER |