NPIMap

Organization Active NPI

Integrated Pain Management SC

  • Pain Medicine (Anesthesiology) Physician
  • Lombard, IL
National Provider Identifier
1447290713
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
036-105506 Issued in IL
Legal business name
INTEGRATED PAIN MANAGEMENT SC
Practice address
244 E Roosevelt Rd
Lombard, IL 60148-4647
Phone
(312) 842-4588
Fax
(312) 635-0108
NPI assigned
Jun 7, 2006
Last updated
May 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Authorized official

Name
Tian Xia, DONPI 1467492728
Title
Owner
Phone
(312) 842-4588

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
Pain Medicine (Anesthesiology) Physician 207LP2900X 036-105506 IL Primary
Non-Pharmacy Dispensing Site 332900000X NU

Addresses

Primary practice location

244 E Roosevelt Rd
Lombard, IL 60148-4647

Mailing address

244 E Roosevelt Rd
Lombard, IL 60148-4647
Phone (312) 842-4588

Other identifiers 1

IdentifierTypeStateIssuer
036105506MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040826001155 IL Part B Supplier - Clinic/Group Practice 2466427158 Receives reassigned benefits from 35 practitioners
1 other NPI on this enrollment
Practice locations: Lombard, IL
O20111108000404 IL DME Supplier - Physician - Interventional Pain Management 2466427158 Practice locations: Lombard, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

819 Campus Dr
Joliet, IL 60435
Phone (630) 629-6298

244 E Roosevelt Rd
Lombard, IL 60148
Phone (312) 842-4588

Interoperability endpoints

  • Direct secure messaging: referrals@ipm.ezdocsdirect.com

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1447290713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 E ROOSEVELT RD",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484647",
            "telephone_number": "312-842-4588",
            "fax_number": "630-599-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 E ROOSEVELT RD",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484647",
            "telephone_number": "312-842-4588",
            "fax_number": "312-635-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PAIN MANAGEMENT SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "XIA",
        "authorized_official_first_name": "TIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-842-4588",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036-105506",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105506",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lombard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.