NGX Illinois SC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

NGX ILLINOIS SC

Practice address

456 Nelson Rd
New Lenox, IL 60451-2946

Phone

(815) 527-6411

Fax

(815) 527-6411

NPI assigned

Dec 30, 2022

Organization subpart

No

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

Authorized official

Name

Eric Speer

Title

Chief Financial & Human Resources

Phone

(720) 339-0188

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 8

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

• Richelle Theresa Headley, APN, FNP-C

  • Family Nurse Practitioner
  • Willowbrook, IL
  • NPI 1649867821
  Medicare reassignment NPD
• Ashley Lillian Locus, NP

  • Nurse Practitioner
  • Winfield, IL
  • NPI 1487255568
  Medicare reassignment NPD
• John D. Mikuzis, DO

  • Physical Medicine & Rehabilitation Physician
  • Shorewood, IL
  • NPI 1629048178
  Medicare reassignment NPD
• Ravi M. Shah

  • Sports Medicine (Family Medicine) Physician
  • Tinley Park, IL
  • NPI 1326579103
  Medicare reassignment NPD
• Diep Tran, NP

  • Family Nurse Practitioner
  • Skokie, IL
  • NPI 1154969418
  Medicare reassignment NPD
• Melissa A Verdecchia, APRN, FNP-BC

  • Family Nurse Practitioner
  • Aurora, IL
  • NPI 1295259042
  Medicare reassignment NPD
• John Paul Ham, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Shorewood, IL
  • NPI 1508961376
  Medicare reassignment
• Sujin Lee, M.D

  • Spinal Cord Injury Medicine Physician
  • Jacksonville, FL
  • NPI 1073829909

  Physical Medicine & Rehabilitation

  NPD

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

{
    "created_epoch": "1672358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1194438515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "456 NELSON RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512946",
            "telephone_number": "815-527-6411",
            "fax_number": "815-527-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 NELSON RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512946",
            "telephone_number": "815-527-6411",
            "fax_number": "815-527-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NGX ILLINOIS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-30",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "SPEER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF FINANCIAL & HUMAN RESOURCES",
        "authorized_official_telephone_number": "720-339-0188"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Lenox Anesthesia LLC
• New Lenox Chiropractic Center LTD
• New Lenox Family Eyecare LTD
• New Lenox Fire Protection District
• New Lenox School District 122
• Nicole Graves, DDS, PC
• Hollie Ann Nieland, FNP-BC
• James T Niemeyer, DO
• Megan Kathleen Niemiec, MSN, FNP-BC
• Anna Nikitscher, COTA/L

• Physical Medicine & Rehabilitation Physician in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Physical Medicine & Rehabilitation Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.