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FAMILY MEDICAL GROUP OF LAGRANGE NPI 1609806421


NPI Information

NPI: 1609806421
Provider Name: FAMILY MEDICAL GROUP OF LAGRANGE
Classification: Exclusive Provider Organization - 302F00000X
Entity Type: Organization

CLIA Number: 14D0691758

Address:
1415 W 47TH ST
LA GRANGE, IL
ZIP 60525
Phone: (708) 579-9375
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FAMILY MEDICAL GROUP OF LAGRANGE is an exclusive provider organization in La Grange, IL. The provider is (1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations. FAMILY MEDICAL GROUP OF LAGRANGE NPI is 1609806421. The provider is registered as an organization entity type.

The provider's business location address is:

1415 W 47TH ST
LA GRANGE, IL
ZIP 60525-136
Phone: (708) 579-9375
Fax: (708) 579-9378

The provider's authorized official is Olga Bartolomeo .
The authorized official title is Manager and has the following contact phone number (708) 579-9375.

The CLIA number assigned to this NPI record is 14D0691758 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/4/2006 and was last updated on 12/11/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1302F00000XExclusive Provider OrganizationYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1521400OTHERILLINOISMEDICARE GROUP
2K21213MEDICARE PINILLINOIS
3F81268MEDICARE UPINILLINOIS
4D12904MEDICARE UPINILLINOIS
5L67024MEDICARE PINILLINOIS
6L67025MEDICARE PINILLINOIS
7I42307MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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