NPIMap

Organization Active NPI

Integra Healthcare SC

  • Internal Medicine Physician
  • Waukegan, IL
National Provider Identifier
1083000350
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.128223 Issued in IL
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
Last updated
Jan 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Authorized official

Name
Sachin Jain, MDNPI 1326292228
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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
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 Directory

Locations

2504 Washington St
Ste 102
Waukegan, IL 60085
Phone (847) 623-7590

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

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.

Verify at the official NPI Registry.