NPIMap

Organization Active NPI

Lake County Physical Medicine, S.C.

  • Physical Medicine & Rehabilitation Physician
  • Grayslake, IL
National Provider Identifier
1558799924
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
036.042751 Issued in IL
Legal business name
LAKE COUNTY PHYSICAL MEDICINE, S.C.
Practice address
15 Commerce Dr
108
Grayslake, IL 60030-7807
Phone
(847) 223-3158
NPI assigned
Oct 23, 2013
Last updated
Feb 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

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

Authorized official

Name
Justin Atkinson, D.C.NPI 1144425489
Title
President
Phone
(847) 223-3158

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209-009124 IL
Internal Medicine Physician 207R00000X 036.042751 IL
Physical Medicine & Rehabilitation Physician 208100000X 036.042751 IL Primary
General Practice Physician 208D00000X

Addresses

Primary practice location

15 Commerce Dr
108
Grayslake, IL 60030-7807

Mailing address

15 Commerce Dr
108
Grayslake, IL 60030-7807
Phone (847) 223-3158

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1382486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1558799924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 COMMERCE DR",
            "address_2": "108",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307807",
            "telephone_number": "847-223-3158",
            "fax_number": "888-481-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 COMMERCE DR",
            "address_2": "108",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307807",
            "telephone_number": "847-223-3158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY PHYSICAL MEDICINE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-23",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "ATKINSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-223-3158",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-009124",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.042751",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "036.042751",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.