NPIMap

Organization Active NPI

Gateway Spine and Pain Physicians, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Bolingbrook, IL
National Provider Identifier
1104013473
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
GATEWAY SPINE AND PAIN PHYSICIANS, LLC
Practice address
215 Remington Blvd
Suite G
Bolingbrook, IL 60440-3656
Phone
(630) 226-1130
Fax
(630) 226-1134
NPI assigned
Oct 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
John K Hong, MDNPI 1932127008
Title
Physician/Owner
Phone
(630) 226-1130

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
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

215 Remington Blvd
Suite G
Bolingbrook, IL 60440-3656

Mailing address

215 Remington Blvd
Suite G
Bolingbrook, IL 60440-3656
Phone (630) 226-1130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080314000583 IL Part B Supplier - Clinic/Group Practice 6507941598 Receives reassigned benefits from 6 practitioners
Practice locations: Bolingbrook, IL; Downers Grove, IL; Hinsdale, IL

National Provider Directory

National Provider Directory

Locations

3253 S Harlem Ave
Ste 4
Berwyn, IL 60402

3551 Highland Ave
#200A
Downers Grove, IL 60515
Phone (844) 376-3876

3551 Highland Ave
Ste 200
Downers Grove, IL 60515
Phone (630) 275-2900

2455 Dean St
Ste S3G
Saint Charles, IL 60175

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AHBHAD

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1104013473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 REMINGTON BLVD",
            "address_2": "SUITE G",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403656",
            "telephone_number": "630-226-1130",
            "fax_number": "630-226-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 REMINGTON BLVD",
            "address_2": "SUITE G",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403656",
            "telephone_number": "630-226-1130",
            "fax_number": "630-226-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY SPINE AND PAIN PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "HONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "630-226-1130",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; 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.