NPIMap

Organization Active NPI

Valley Pain Care Centers LTD

  • Pain Medicine Physician
  • Dekalb, IL
National Provider Identifier
1194722058
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
VALLEY PAIN CARE CENTERS LTD
Practice address
1 Kish Hospital Dr
Dekalb, IL 60115-9602
Phone
(815) 766-1258
Fax
(708) 469-6614
NPI assigned
Jul 6, 2005
Last updated
Jan 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Authorized official

Name
Michael Coulson, D.O.NPI 1255338554
Title
Owner
Phone
(815) 749-8993

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 Physician 208VP0000X NU Primary

Addresses

Primary practice location

1 Kish Hospital Dr
Dekalb, IL 60115-9602

Mailing address

1879 N Neltnor Blvd # 224
West Chicago, IL 60185-5932
Phone (815) 766-1258

Other identifiers 2

IdentifierTypeStateIssuer
CH9839OtherILRAILROAD MEDICARE
0001930204OtherILBCBS GROUP #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000066 IL Part B Supplier - Clinic/Group Practice 7517858632 Receives reassigned benefits from 57 practitioners
Practice locations: Dekalb, IL; Sycamore, IL; Spring Valley, IL; Sandwich, IL; Oswego, IL; North Aurora, IL

National Provider Directory

National Provider Directory

Locations

23 S Lincolnway
North Aurora, IL 60542
Phone (630) 264-8000

1879 N Neltnor Blvd
West Chicago, IL 60185

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1194722058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1879 N NELTNOR BLVD # 224",
            "city": "WEST CHICAGO",
            "state": "IL",
            "postal_code": "601855932",
            "telephone_number": "815-766-1258",
            "fax_number": "630-343-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KISH HOSPITAL DR",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159602",
            "telephone_number": "815-766-1258",
            "fax_number": "708-469-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PAIN CARE CENTERS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A",
        "authorized_official_last_name": "COULSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-749-8993",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH9839",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "0001930204",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; 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.