Lake Immediate Care & Clinic S C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036107391 Issued in IL

Legal business name

LAKE IMMEDIATE CARE & CLINIC S C

Practice address

452 W State Rd Ste D
Island Lake, IL 60042-8438

Phone

(847) 519-1061

NPI assigned

Aug 29, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Eberechukwu Ibe, M.DNPI 1841258043

Title

President

Phone

(708) 606-7219

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12052/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Eberechukwu O Ibe, MD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1841258043
  Medicare reassignment Care Compare group NPD Authorized official
• Reginald A Ebirim, M.D.

  • Family Medicine Physician
  • New London, WI
  • NPI 1396702957

  IL

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1114208642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 W STATE RD STE D",
            "city": "ISLAND LAKE",
            "state": "IL",
            "postal_code": "600428438",
            "telephone_number": "847-519-1061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 W STATE RD STE D",
            "city": "ISLAND LAKE",
            "state": "IL",
            "postal_code": "600428438",
            "telephone_number": "847-519-1061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE IMMEDIATE CARE & CLINIC S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-29",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "IBE",
        "authorized_official_first_name": "EBERECHUKWU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-606-7219",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036113328",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036107391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island Lake Dental LLC
• Island Lake Urgent Care Inc
• J. Lynn James, LCPC
• Cynthia Evans Johnson, L.M.T.
• Michael Kuk, PHARMD
• Deb Lehmann, LCPC
• Lindsey Chiropractic Clinic PC
• Kathleen Margaret Lindsey, D.C.
• Tina Loos, LMT
• Bernice Mahoney

• Internal Medicine Physician in Island Lake, IL
• Providers in Island Lake, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.