NPIMap

Organization Active NPI

Integrated Pain Management SC

  • Interventional Pain Medicine Physician
  • Gurnee, IL
National Provider Identifier
1104620137
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
INTEGRATED PAIN MANAGEMENT SC
Practice address
3900 Washington St Ste U
Gurnee, IL 60031-5706
Phone
(630) 629-6298
Fax
(630) 599-7149
NPI assigned
Apr 1, 2025
Organization subpart
Yes
Parent organization
INTEGRATED PAIN MANAGEMENT SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Authorized official

Name
Brenda Muniz
Title
Credentialing Manager
Phone
(773) 289-0999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

3900 Washington St Ste U
Gurnee, IL 60031-5706

Mailing address

244 E Roosevelt Rd
Lombard, IL 60148-4647

National Provider Directory

National Provider Directory
Tax ID family
Integrated Pain Management7 organizations share this tax ID, including this one
Part of
Integrated Pain Management

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3900 Washington St
Ste U
Gurnee, IL 60031
Phone (630) 629-6298

Practitioners & affiliated clinicians

Practitioners 1

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": "1743465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743465600000",
    "number": "1104620137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 E ROOSEVELT RD",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 WASHINGTON ST STE U",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315706",
            "telephone_number": "630-629-6298",
            "fax_number": "630-599-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PAIN MANAGEMENT SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATED PAIN MANAGEMENT SC",
        "enumeration_date": "2025-04-01",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A",
        "authorized_official_last_name": "MUNIZ",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "773-289-0999"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.