Grayslake Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036095667 Issued in IL

Legal business name

GRAYSLAKE MEDICAL GROUP, LLC

Practice address

900 Technology Way Ste 230
Libertyville, IL 60048-5364

Phone

(847) 548-8269

Fax

(847) 548-8969

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert Romanelli, M.D.NPI 1144208554

Title

President

Phone

(847) 548-8269

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JGHFBA

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert J Romanelli, M.D.

  • Internal Medicine Physician
  • Libertyville, IL
  • NPI 1144208554

  IL

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537228800000",
    "number": "1437236015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 TECHNOLOGY WAY STE 230",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485364",
            "telephone_number": "847-548-8269",
            "fax_number": "847-548-8969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 TECHNOLOGY WAY STE 230",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485364",
            "telephone_number": "847-548-8269",
            "fax_number": "847-548-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYSLAKE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-09-18",
        "status": "A",
        "authorized_official_last_name": "ROMANELLI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-548-8269",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036095667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI/INDIVIDUAL",
            "identifier": "1144208554",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Oaks Surgical, S.C.
• Eliza Eva M. Grant, CNP
• Trysta Allyson Grassel, RBT
• Graybridge Health, NFP
• Kenneth J Grayer Jr.
• Great Lakes Dental P.C.
• Brandi Marie Green, R.N.
• Elizabeth Green, RYT
• Jill C Green, MD
• Michael Steven Greenbaum, MD

• Internal Medicine Physician in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.