NPIMap

Organization Active NPI

Integrative Spine Care, LLC

  • Pain Medicine Physician
  • Carbondale, IL
National Provider Identifier
1447625918
Registry record updated Dec 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
036067084 Issued in IL
Legal business name
INTEGRATIVE SPINE CARE, LLC
Practice address
364 Lake Indian Hills Circle
Carbondale, IL 62903
Phone
(573) 575-6440
Fax
(618) 942-7399
NPI assigned
Dec 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2015

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

Authorized official

Name
Paul B Juergens, M,D.NPI 1922026673
Title
Owner/Provider
Phone
(573) 575-6440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X 036067084 IL Primary

Addresses

Primary practice location

364 Lake Indian Hills Circle
Carbondale, IL 62903

Mailing address

364 Lake Indian Hills Circle
Carbondale, IL 62903
Phone (573) 575-6440

Other identifiers 1

IdentifierTypeStateIssuer
036067084OtherILIL MEDICAL LICENSE

National Provider Directory

National Provider Directory

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": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1447625918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 LAKE INDIAN HILLS CIRCLE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62903",
            "telephone_number": "573-575-6440",
            "fax_number": "618-942-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 LAKE INDIAN HILLS CIRCLE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62903",
            "telephone_number": "573-575-6440",
            "fax_number": "618-942-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE SPINE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2015-12-09",
        "status": "A",
        "authorized_official_last_name": "JUERGENS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "573-575-6440",
        "authorized_official_credential": "M,D."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IL",
            "license": "036067084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL MEDICAL LICENSE",
            "identifier": "036067084",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; 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.