NPIMap

Individual provider Active NPI

Paul C Tack, M.D.

  • Internal Medicine Physician
  • Gurnee, IL
National Provider Identifier
1265446017
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036097015 Issued in IL
Practice address
501 N Riverside Dr
Suite 102
Gurnee, IL 60031-5918
Phone
(847) 625-8300
Fax
(847) 625-8862
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036097015 IL Primary

Addresses

Primary practice location

501 N Riverside Dr
Suite 102
Gurnee, IL 60031-5918

Mailing address

501 N Riverside Dr
Suite 216
Gurnee, IL 60031-5918
Phone (847) 625-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040726000381 IL Practitioner - Internal Medicine 9335129634 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Emory University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

501 N Riverside Dr
Suite 216
Gurnee, IL 60031-5918
Phone (847) 814-2728

Hospital & facility affiliations

  • Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Reliable Visiting Physicians Inc CurrentSince Feb 3, 2018 Accepting new patients
Skyline Physicians LLC Internal Medicine CurrentSince Oct 26, 2015 Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine Current Accepting new patients
Cep America-Illinois Hospitalists CurrentSince May 1, 2014 Accepting new patients
Cep America-Illinois Hospitalists Internal Medicine CurrentSince May 1, 2014 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2860 S River Rd
Ste 360
Des Plaines, IL 60018
Phone (847) 376-8144

1200 Roosevelt Rd
Ste 140
Glen Ellyn, IL 60137
Phone (708) 307-2103

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

Interoperability endpoints

  • Direct secure messaging: paul.tack.1@29898.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406592000000",
    "number": "1265446017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N RIVERSIDE DR",
            "address_2": "SUITE 216",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315918",
            "telephone_number": "847-625-8300",
            "fax_number": "847-625-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N RIVERSIDE DR",
            "address_2": "SUITE 102",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315918",
            "telephone_number": "847-625-8300",
            "fax_number": "847-625-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACK",
        "first_name": "PAUL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2014-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036097015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

Verify at the official NPI Registry.