Neurocenter S C

Primary specialty

SpecialistTaxonomy code 174400000X

License

036048770 Issued in IL

Legal business name

NEUROCENTER S C

Practice address

6225 W Touhy Ave
Chicago, IL 60646-1105

Phone

(773) 775-7540

NPI assigned

Apr 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jose L. Medina, MD

Title

Ceo and Medical Director

Phone

(773) 775-7540

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290556800000",
    "number": "1295950517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 N PAULINA ST",
            "address_2": "SUITE 325",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402756",
            "telephone_number": "773-775-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6225 W TOUHY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606461105",
            "telephone_number": "773-775-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROCENTER S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2010-11-24",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO AND MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "773-775-7540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036048770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036048770",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Chicago, IL
• Providers in Chicago, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.