Guardian Interventional Pain Management Institute LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

GUARDIAN INTERVENTIONAL PAIN MANAGEMENT INSTITUTE LLC

Practice address

2203 Eastland Dr Ste 7
Bloomington, IL 61704-7924

Phone

(309) 808-1700

NPI assigned

Jun 12, 2017

Organization subpart

No

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

Authorized official

Name

Mohamed El-Ansary, M.D.

Title

Owner

Phone

(217) 274-9720

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497225600000",
    "number": "1053840124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 570",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600450570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2203 EASTLAND DR STE 7",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047924",
            "telephone_number": "309-808-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN INTERVENTIONAL PAIN MANAGEMENT INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-12",
        "last_updated": "2017-06-12",
        "status": "A",
        "authorized_official_last_name": "EL-ANSARY",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-274-9720",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alice Dorine Grooms, RN
• Amanda Gruber, DPT
• Gregory V Guard, MD
• Guardian Headache & Pain Management Institute
• Guardian Headache & Pain Management Institute LLC
• Nicolas Gudino Jr.
• Stephanie M Guerra
• Bhawna Gupta, PT
• Rakesh Kumar Gupta, MD
• Aaron Jermaine Guzman

• Pain Medicine (Anesthesiology) Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Pain Medicine (Anesthesiology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; 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.