Individual provider Active NPI

Paul Michael Lacanienta, MD

  • Neurocritical Care Physician
  • Chicago, IL
National Provider Identifier
1588291348
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
License
036.170809 Issued in IL
Practice address
1620 W Harrison St
Chicago, IL 60612-3801
Phone
(312) 942-5000
NPI assigned
Mar 23, 2020
Last updated
Jul 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Neurocritical Care Physician 2084A2900X 036.170809 IL Primary

Addresses

Primary practice location

1620 W Harrison St
Chicago, IL 60612-3801

Mailing address

1620 W Harrison St
Chicago, IL 60612-3801

Other practice location 1

11100 Euclid Ave
Cleveland, OH 44106-1716
Phone (844) 885-7283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200610003138 OH Order and Referring Only - NeurologyPractitioner - Neurology 0547681991

Care Compare profile

Medicare Care Compare
Specialty
Neuropsychiatry
Education
Indiana University School of Medicine, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3030 Northwest Expressway
Suite 1000
Oklahoma City, OK 73112-5468

730 N Milwaukee Ave
Chicago, IL 60642-6023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.170809ILMDNeurocritical Care Physician

NPI Registry JSON

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1588291348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123801",
            "telephone_number": "312-942-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11100 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441061716",
            "country_code": "US",
            "telephone_number": "844-885-7283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACANIENTA",
        "first_name": "PAUL",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "IL",
            "license": "036.170809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.