Organization Active NPI

G. Spitz, M.D., LTD

  • Surgery Physician
  • Aurora, IL
National Provider Identifier
1457465866
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
G. SPITZ, M.D., LTD
Practice address
1256 Waterford Dr
Suite 130
Aurora, IL 60504-4510
Phone
(630) 820-2727
Fax
(630) 820-7427
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Authorized official

Name
Lornell E Hansen II, MDNPI 1881640233
Title
Owner
Phone
(605) 274-0217

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
Phlebology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 202K00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1256 Waterford Dr
Suite 130
Aurora, IL 60504-4510

Mailing address

1256 Waterford Dr
Suite 130
Aurora, IL 60504-4510
Phone (630) 820-2727

Other identifiers 1

IdentifierTypeStateIssuer
216477OtherPTAN MEDICARE

Other names 1

  • SPITZ & BRAXTON, LTD Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080508000700 IL Part B Supplier - Clinic/Group Practice 7517046097 Receives reassigned benefits from 6 practitioners
Practice locations: Saint Charles, IL; Aurora, IL

National Provider Directory

National Provider Directory

Locations

1256 Waterford Dr
Ste 130
Aurora, IL 60504
Phone (630) 820-2727

5980 Route 53
Ste D
Lisle, IL 60532
Phone (630) 515-8930

2210 Dean St
Ste N1
St Charles, IL 60175
Phone (630) 513-9077

2210 Dean St
Ste G
St Charles, IL 60175
Phone (630) 820-2727

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1457465866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 WATERFORD DR",
            "address_2": "SUITE 130",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044510",
            "telephone_number": "630-820-2727",
            "fax_number": "630-820-7427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1256 WATERFORD DR",
            "address_2": "SUITE 130",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044510",
            "telephone_number": "630-820-2727",
            "fax_number": "630-820-7427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G. SPITZ, M.D., LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "LORNELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-274-0217",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN MEDICARE",
            "identifier": "216477",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPITZ & BRAXTON, LTD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.