Provider Demographics
NPI:1477726610
Name:J.E.BERTOLINI ,M.D. SC.
Entity Type:Organization
Organization Name:J.E.BERTOLINI ,M.D. SC.
Other - Org Name:ADVANTACARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERTOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-4104
Mailing Address - Street 1:202 N HAMMES AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8129
Mailing Address - Country:US
Mailing Address - Phone:815-741-4104
Mailing Address - Fax:815-741-4135
Practice Address - Street 1:202 N HAMMES AVE
Practice Address - Street 2:SUITE D
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8129
Practice Address - Country:US
Practice Address - Phone:815-741-4104
Practice Address - Fax:815-741-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057862Medicaid
IL1477726610Medicare PIN
ILC45683Medicare UPIN
IL036057862Medicaid