NPIMap

Organization Active NPI

St. Charles Pain and Wellness Center, LLC

  • Chiropractor
  • St Charles, IL
National Provider Identifier
1225338353
Registry record updated Oct 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038010924 Issued in IL
Legal business name
ST. CHARLES PAIN AND WELLNESS CENTER, LLC
Practice address
3755 E Main St
Suite185
St Charles, IL 60174-2463
Phone
(630) 513-7770
Fax
(630) 513-7778
NPI assigned
Oct 22, 2010
Last updated
Oct 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2010

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

Authorized official

Name
Dr. Jacob Michael Hertz, D.C.NPI 1083841837
Title
Owner
Phone
(563) 505-2402

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038010924 IL Primary

Addresses

Primary practice location

3755 E Main St
Suite185
St Charles, IL 60174-2463

Mailing address

3755 E Main St
Suite185
St Charles, IL 60174-2463
Phone (630) 513-7770

Other names 1

  • Dr. Jacob M. Hertz Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110111000069 IL Part B Supplier - Clinic/Group Practice 4385833110 Receives reassigned benefits from 1 practitioner
Practice locations: St Charles, IL

National Provider Directory

National Provider Directory

Locations

3755 E Main St
Ste 185
St Charles, IL 60174
Phone (630) 513-7770

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287705600000",
    "number": "1225338353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3755 E MAIN ST",
            "address_2": "SUITE185",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742463",
            "telephone_number": "630-513-7770",
            "fax_number": "630-513-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3755 E MAIN ST",
            "address_2": "SUITE185",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742463",
            "telephone_number": "630-513-7770",
            "fax_number": "630-513-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES PAIN AND WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-22",
        "last_updated": "2010-10-22",
        "status": "A",
        "authorized_official_last_name": "HERTZ",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-505-2402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Jacob M. Hertz",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2010; 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.