NPIMap

Organization Active NPI

Chicago Pain Medicine Center

  • Interventional Pain Medicine Physician
  • Chicago, IL
National Provider Identifier
1407323843
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
CHICAGO PAIN MEDICINE CENTER
Practice address
5215 N California Ave Ste F717
Chicago, IL 60625-8562
Phone
(773) 868-6824
NPI assigned
Oct 24, 2018
Last updated
Jul 9, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CHICAGO PAIN MEDICINE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Authorized official

Name
James R DiesfeldNPI 1497753214
Title
President
Phone
(773) 868-6824

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

5215 N California Ave Ste F717
Chicago, IL 60625-8562

Mailing address

1044 N Francisco Ave
Chicago, IL 60622-2743
Phone (773) 868-6824

Other identifiers 1

IdentifierTypeStateIssuer
036086023MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Chicago Pain Medicine Center6 organizations share this tax ID, including this one
Part of
Chicago Pain Medicine Center

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5215 N California Ave
Ste F717
Chicago, IL 60625
Phone (773) 271-9786

Practitioners & affiliated clinicians

Practitioners 1

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": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1407323843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N FRANCISCO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222743",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N CALIFORNIA AVE STE F717",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606258562",
            "telephone_number": "773-868-6824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO PAIN MEDICINE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHICAGO PAIN MEDICINE CENTER",
        "enumeration_date": "2018-10-24",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "DIESFELD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-868-6824"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086023",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.