NPIMap

Organization Active NPI

Illinois Pain Specialists, LLC

  • Pain Medicine Physician
  • Gurnee, IL
National Provider Identifier
1639484512
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
036.115520 Issued in IL
Legal business name
ILLINOIS PAIN SPECIALISTS, LLC
Practice address
1790 Nations Dr
Suite 111
Gurnee, IL 60031-9164
Phone
(773) 307-3009
NPI assigned
Aug 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Authorized official

Name
Bojan Pavlovic, MD
Title
President
Phone
(773) 307-3009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X 036.115520 IL Primary

Addresses

Primary practice location

1790 Nations Dr
Suite 111
Gurnee, IL 60031-9164

Mailing address

601 Washington Ave
390
Newport, KY 41071-1986
Phone (859) 291-4800

Other identifiers 1

IdentifierTypeStateIssuer
4301089505OtherILLICENSE NUMBER

National Provider Directory

National Provider Directory

Locations

1790 Nations Dr
Ste 111
Gurnee, IL 60031
Phone (224) 656-5867

NPI Registry JSON

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1639484512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 WASHINGTON AVE",
            "address_2": "390",
            "city": "NEWPORT",
            "state": "KY",
            "postal_code": "410711986",
            "telephone_number": "859-291-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 NATIONS DR",
            "address_2": "SUITE 111",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600319164",
            "telephone_number": "773-307-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS PAIN SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-16",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "PAVLOVIC",
        "authorized_official_first_name": "BOJAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-307-3009",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IL",
            "license": "036.115520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4301089505",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; 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.