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Organization Active NPI

Ganesha Institute of Neurology and Psychiatry SC

Doing business as A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry

  • Neurology Physician
  • Libertyville, IL
National Provider Identifier
1629478599
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Doing business as
A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry
Practice address
1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone
(847) 816-6335
Fax
(847) 816-6355
NPI assigned
Aug 28, 2014
Last updated
Jan 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Lori A Smith
Title
Practice Manager
Phone
(847) 816-6441

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Psychologist 103T00000X NU
Clinical Social Worker 1041C0700X NU
Neurology Physician 2084N0400X NU Primary
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312

Mailing address

1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone (847) 816-6335

Other practice location 1

1850 W Winchester Rd Ste 105
Libertyville, IL 60048-5357
Phone (847) 816-6335

Other names 1

  • A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20141104000962 IL Part B Supplier - Clinic/Group Practice 0042432296 Receives reassigned benefits from 37 practitioners
Practice locations: Libertyville, IL
O20221214000103 WI Part B Supplier - Clinic/Group Practice 0042432296 Receives reassigned benefits from 23 practitioners
1 other NPI on this enrollment
Practice locations: Kenosha, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

150 E Cook Ave
Ste 100
Libertyville, IL 60048
Phone (847) 816-3556

1850 W Winchester Rd
Ste 105
Libertyville, IL 60048
Phone (847) 816-6335

1850 W Winchester Rd
Ste 115
Libertyville, IL 60048
Phone (847) 816-6335

1860 W Winchester Rd
Ste 106
Libertyville, IL 60048
Phone (847) 599-0715

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1629478599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD STE 106",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485312",
            "telephone_number": "847-816-6335",
            "fax_number": "847-816-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD STE 106",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485312",
            "telephone_number": "847-816-6335",
            "fax_number": "847-816-6355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1850 W Winchester Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600485357",
            "country_code": "US",
            "telephone_number": "847-816-6335",
            "fax_number": "847-816-6355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-28",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "847-816-6441"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.