FOX RIDGE MEDICAL ASSOCIATES, LLC (NPI# 1013402825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013402825 |
| Entity Type | Organization |
| Organization Name | FOX RIDGE MEDICAL ASSOCIATES, LLC |
| Practice Address |
3633 Municipal Dr Mchenry IL 60050 |
| Mailing Address |
3633 Municipal Dr Mchenry IL 60050-5434 |
| Practice Telephone | 8158615543 |
| Mailing Telephone | 7792443072 |
| Mailing Fax Number | 8153318389 |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2018-08-28 |
| Authorized Official Name | DR. JEFFREY SCOTT TOMLIN (PRACTICE OWNER) |
| Authorized Official Telephone | 8158615543 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 036.092485 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PTAN | F100494732 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205322716 | Fox Ridge Medical Associates, LLC | Clinic/Center | 3633 Municipal Dr, Mchenry, IL 60050-5434 | 2018-07-09 |
| Street Address |
3633 MUNICIPAL DR |
| City | MCHENRY |
| State | IL |
| Zip Code | 60050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144861394 | Kaitlyn M Kanakes | Internal Medicine | 3633 Municipal Dr, Mchenry, IL 60050-5434 | 2019-09-30 |
| 1205322716 | Fox Ridge Medical Associates, LLC | Clinic/Center | 3633 Municipal Dr, Mchenry, IL 60050-5434 | 2018-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932728003 | Tco Jv, LLC | Skilled Nursing Facility | 550 Ridgeview Drive, Mchenry, IL 60050 | 2020-04-09 |
| 1992274971 | Lisa Luedtke | Counselor | 5342 West Elm Street, Mchenry, IL 60050 | 2018-11-19 |
| 1700387065 | Richard Stacy Birmantas | Speech-Language Pathologist | 6515 West Route 120, Mchenry, IL 60050 | 2018-02-22 |
| 1659888774 | Kathleen Mather | Speech-Language Pathologist | 3502 Washington St, Mchenry, IL 60050 | 2018-01-10 |
| 1891205605 | Delorean Mckinney | Psychologist | 4031 Dayton Ave, Mchenry, IL 60050 | 2017-10-06 |
| 1851810741 | Diana Park | Pharmacist | 2253 N. Richmond Rd., Mchenry, IL 60050 | 2017-09-12 |
| 1063931921 | Lauren M Young | Counselor | 4031 W. Dayton Street, Mchenery, IL 60050 | 2017-09-12 |
| 1376086264 | Elizabeth Kathleen Zacher | Social Worker | 4100 W Dayton Street, Mchenry, IL 60050 | 2016-11-23 |
| 1700332491 | Jasmine Elias | Social Worker | 4031 Dayton St, Mchenry, IL 60050 | 2016-09-01 |
| 1144776360 | Michal Jakub Kubiak | Internal Medicine | 4111 W. Lillian Street Apt. F, Mchenry, IL 60050 | 2016-08-28 |
| Find all providers in zip 60050 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801381900 | Nikita Jain | Internal Medicine | 4309 W Medical Center Dr # A, Mchenry, IL 60050-8419 | 2018-06-30 |
| 1144776360 | Michal Jakub Kubiak | Internal Medicine | 4111 W. Lillian Street Apt. F, Mchenry, IL 60050 | 2016-08-28 |
| 1689027096 | Zubina Sehrish Unjom | Internal Medicine | 4201 W Medical Center Drive, Mchenry, IL 60050 | 2016-07-20 |
| 1063843670 | Jenie Nepomuceno | Internal Medicine | 4309 W Medical Center Dr Ste B207, Mchenry, IL 60050-8439 | 2013-12-07 |
| 1255407805 | Sanjukta Mitra | Internal Medicine | 633 Ridgeview Drive, Mchenry, IL 60050-7012 | 2006-11-27 |
| 1437224441 | Daniel J. O'rourke | Internal Medicine | 4302 W Crystal Lake Rd Ste B, Mchenry, IL 60050-4248 | 2006-11-22 |
| 1962510537 | Ifzal K Bangash M.d.s.c. | Internal Medicine | 4314 W Crystal Lake Rd, Suite D, Mchenry, IL 60050-4211 | 2006-08-25 |
| 1023029717 | Parmod Narang | Internal Medicine | 4318 W Crystal Lake Rd, Ste J Drs Narang and Associates Ltd, Mchenry, IL 60050-4210 | 2006-08-10 |
| 1215985387 | Erin C Davis-delay | Internal Medicine | 2507 N Richmond Rd, Mchenry, IL 60051 | 2006-05-04 |
| 1639163850 | Jeffrey Scott Tomlin | Internal Medicine | 3633 Municipal Dr., Mchenry, IL 60050 | 2005-09-02 |
| Find all providers in MCHENRY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.