Active NPI
Integra Healthcare SC
- Internal Medicine Physician
- Waukegan, IL
National Provider Identifier
1083000350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036.128223
- Legal business name
- INTEGRA HEALTHCARE SC
- Practice address
- 2504 Washington St Ste 102
Waukegan, IL 60085-4960 - Phone
- (847) 623-7590
- Fax
- (847) 623-7591
- NPI assigned
- Apr 13, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sachin Jain, MD
- Title
- Owner
- Phone
- (847) 623-7590
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036.128223 | IL | Primary |
Addresses
Primary practice location
2504 Washington St Ste 102
Waukegan, IL 60085-4960
Mailing address
5 Timberwood LN
Riverwoods, IL 60015-2463
Phone (847) 858-2083
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150512000922 | IL | Part B Supplier - Clinic/Group Practice | 0042539173 |
Receives reassigned benefits from 18 practitioners Practice locations: Waukegan, IL; Zion, IL |
National Provider Directory
National Provider DirectoryLocations
2504 Washington St
Waukegan, IL 60085
Phone (847) 336-2288
Practitioners & affiliated clinicians
Practitioners 20
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Primary Care Nurse Practitioner
- Wheeling, IL
- NPI 1134823354
IL, Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1546560000000",
"number": "1083000350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 TIMBERWOOD LN",
"city": "RIVERWOODS",
"state": "IL",
"postal_code": "600152463",
"telephone_number": "847-858-2083",
"fax_number": "224-235-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2504 WASHINGTON ST STE 102",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600854960",
"telephone_number": "847-623-7590",
"fax_number": "847-623-7591"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTEGRA HEALTHCARE SC",
"organizational_subpart": "NO",
"enumeration_date": "2015-04-13",
"last_updated": "2019-01-04",
"status": "A",
"authorized_official_last_name": "JAIN",
"authorized_official_first_name": "SACHIN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "847-623-7590",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "IL",
"license": "036.128223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.