Grand Vein Specialists LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-116087 Issued in IL

Legal business name

GRAND VEIN SPECIALISTS LLC

Practice address

4952 W Irving Park Rd Ste 300
Chicago, IL 60641-2693

Phone

(773) 942-6141

Fax

(866) 707-2267

NPI assigned

Feb 6, 2012

Last updated

Feb 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Javier FloresNPI 1164445854

Title

Owner

Phone

(773) 942-6141

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/4283/brand/1/csg/1/fhir/r4

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.

• Javier Flores, M.D.,M.P.H.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1164445854

  Multi-Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Juanita Mora, MD

  • Allergy & Immunology Physician
  • Chicago, IL
  • NPI 1750557179
  Medicare reassignment Care Compare group NPD
• Alicia Estrada, FNP

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1003510751
  Medicare reassignment NPD
• Victor Munoz, M.D.

  • Family Medicine Physician
  • Park Ridge, IL
  • NPI 1992962146
  Medicare reassignment NPD
• Libin Manuel Zevallos, FNP-BC

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1649637976
  Medicare reassignment NPD

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1255603247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4952 W IRVING PARK RD STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412693",
            "telephone_number": "773-942-6141",
            "fax_number": "866-707-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4952 W IRVING PARK RD STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412693",
            "telephone_number": "773-942-6141",
            "fax_number": "866-707-2267"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6227 Cermak Rd",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604022317",
            "country_code": "US",
            "telephone_number": "773-942-6141",
            "fax_number": "866-707-2267",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1508 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Waukegan",
            "state": "IL",
            "postal_code": "600853653",
            "country_code": "US",
            "telephone_number": "773-942-6141",
            "fax_number": "866-707-2267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAND VEIN SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "JAVIER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-942-6141"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-116087",
            "primary": true
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "IL",
            "license": "036-116087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand Home Health Care, Inc.
• Grand Medical Clinic, Inc
• Grand Michigan Dentistry, PC
• Grand Pharmacy LLC
• Grand Smiles 2 (Grand Smiles)
• Amy Grand, RN
• Kenyon Jacob Grand, DO
• Gabriela Mercedes Granda
• Hilda Granda
• Bre'Shae Grandberry, LCSW

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; 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.