Great River Pain Center LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

036118384 Issued in IL

Legal business name

GREAT RIVER PAIN CENTER LLC

Practice address

1634 Avenue of the Cities
Moline, IL 61265-4860

Phone

(309) 762-9711

Fax

(309) 762-9747

NPI assigned

Oct 11, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Sanjay Sundar, MD

Title

Owner

Phone

(312) 613-9999

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Great River Pain Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Great River Pain Clinic LLC

  • Pain Clinic/Center
  • Galesburg, IL
  • NPI 1134597636
  NPD tax ID

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1073865291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1634 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654860",
            "telephone_number": "309-762-9711",
            "fax_number": "309-762-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654860",
            "telephone_number": "309-762-9711",
            "fax_number": "309-762-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-11",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "SUNDAR",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-613-9999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IL",
            "license": "036118384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036118384",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayashree T. Gowda, M.D.
• Kathryn Anne Grage, MS, CCC-SLP
• Dalton Jo Gravert
• Great River Family Chiropractic
• Great River Family Wellness
• Cynthia M Green, LCPC
• Miriam L Greene
• Ryan L Greene
• Justina Greer, CD(DONA), CLC, SBD
• Kathryn Greer, RDN, LDN

• Pain Medicine Physician in Moline, IL
• Providers in Moline, IL by specialty
• Pain Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; 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.