Active NPI
Open Advanced MRI of Crystal Lake, LLC
- Diagnostic Radiology Physician
- Crystal Lake, IL
National Provider Identifier
1093770851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- OPEN ADVANCED MRI OF CRYSTAL LAKE, LLC
- Practice address
- 820 E Terra Cotta Ave
Suite 136
Crystal Lake, IL 60014-3649 - Phone
- (815) 444-1330
- Fax
- (815) 444-1279
- NPI assigned
- Apr 17, 2006
- 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
- Mary Pat Houlihan
- Title
- Director
- Phone
- (815) 444-1330
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | IL | Primary |
Addresses
Primary practice location
820 E Terra Cotta Ave
Suite 136
Crystal Lake, IL 60014-3649
Mailing address
820 E Terra Cotta Ave
Suite 136
Crystal Lake, IL 60014-3649
Phone (815) 444-1330
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CK3870 | Other | IL | RAILROAD MEDICARE |
| 05630041 | Other | IL | BLUE SHIELD |
National Provider Directory
National Provider DirectoryLocations
Dept 4681
Carol Stream, IL 60122
820 E Terra Cotta Ave
Ste 129
Crystal Lake, IL 60014
Phone (815) 444-1330
20530 N Rand Rd
Ste 350
Deer Park, IL 60010
Phone (847) 550-6740
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Chagrin Falls, OH
- NPI 1124088984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1093770851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 E TERRA COTTA AVE",
"address_2": "SUITE 136",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600143649",
"telephone_number": "815-444-1330",
"fax_number": "815-444-1279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 E TERRA COTTA AVE",
"address_2": "SUITE 136",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600143649",
"telephone_number": "815-444-1330",
"fax_number": "815-444-1279"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OPEN ADVANCED MRI OF CRYSTAL LAKE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-17",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "HOULIHAN",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "PAT",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "815-444-1330"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CK3870",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "05630041",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.