NPIMap

Organization Active NPI

Core Orthopedics & Sports Medicine LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Elk Grove Village, IL
National Provider Identifier
1093918161
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
CORE ORTHOPEDICS & SPORTS MEDICINE LLC
Practice address
555 Biesterfield Rd
Elk Grove Village, IL 60007-3306
Phone
(847) 690-1776
Fax
(847) 690-1777
NPI assigned
Jun 7, 2007
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Daniel T Kuesis, M.D.NPI 1679573240
Title
Owner
Phone
(847) 690-1776

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
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

555 Biesterfield Rd
Elk Grove Village, IL 60007-3306

Mailing address

555 Biesterfield Rd
Elk Grove Village, IL 60007-3306
Phone (847) 690-1776

Other identifiers 1

IdentifierTypeStateIssuer
DG8924OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20070807000204 IL Part B Supplier - Clinic/Group Practice 1850482712 Receives reassigned benefits from 22 practitioners
Practice locations: Elk Grove Village, IL; Hoffman Estates, IL
O20110912000084 IL DME Supplier - Physician - Orthopedic/Orthopedic Surgery 1850482712 Practice locations: Elk Grove Village, IL
O20181213002181 WI Part B Supplier - Clinic/Group Practice 1850482712 Receives reassigned benefits from 15 practitioners
Practice locations: Genoa City, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

119 Elizabeth Ln
Genoa City, WI 53128
Phone (224) 678-1080

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1093918161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 BIESTERFIELD RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073306",
            "telephone_number": "847-690-1776",
            "fax_number": "847-690-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 BIESTERFIELD RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073306",
            "telephone_number": "847-690-1776",
            "fax_number": "847-690-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE ORTHOPEDICS & SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "KUESIS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-690-1776",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DG8924",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove Village, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.