NPIMap

Organization Active NPI

Congress Vein Clinic LLC

  • Trauma Surgery Physician
  • Chicago, IL
National Provider Identifier
1467986901
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
Legal business name
CONGRESS VEIN CLINIC LLC
Practice address
41 W Congress Pkwy
1St Floor
Chicago, IL 60605-1531
Phone
(847) 593-8460
Fax
(224) 246-8042
NPI assigned
Apr 11, 2017
Last updated
Apr 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Authorized official

Name
Yan Katsnelson, MDNPI 1285672840
Title
Ceo
Phone
(847) 257-1244

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0127X Primary

Addresses

Primary practice location

41 W Congress Pkwy
1St Floor
Chicago, IL 60605-1531

Mailing address

304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 257-1244

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180316001093 IL Part B Supplier - Clinic/Group Practice 6709148414 Receives reassigned benefits from 14 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

41 W Ida B Wells Dr
Ste B
Chicago, IL 60605

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1467986901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WAINWRIGHT DR",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621900",
            "telephone_number": "847-257-1244",
            "fax_number": "224-246-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 W CONGRESS PKWY",
            "address_2": "1ST FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606051531",
            "telephone_number": "847-593-8460",
            "fax_number": "224-246-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONGRESS VEIN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "YAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-257-1244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 11, 2017; 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.