Modernmed Recovery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

MODERNMED RECOVERY, LLC

Practice address

111 S Washington Ave Ste 202
Park Ridge, IL 60068-4293

Phone

(847) 423-6800

NPI assigned

Jan 20, 2025

Organization subpart

No

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

Authorized official

Name

Ian Gershman, MBA, MA

Title

Senior Consultant

Phone

(609) 703-5006

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1737331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1649081548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S WASHINGTON AVE STE 202",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684293",
            "telephone_number": "847-423-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S WASHINGTON AVE STE 202",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684293",
            "telephone_number": "847-423-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERNMED RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-20",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "GERSHMAN",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "SENIOR CONSULTANT",
        "authorized_official_telephone_number": "609-703-5006",
        "authorized_official_credential": "MBA, MA"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Mizock, LCPC
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• Ami Deepak Modi, DO
• Lesha Modi
• Mary Catherine Moellering, MD
• Michael D Moen, M.D.
• Robert Carl Moen, D.D.S.

• Substance Use Disorder Rehabilitation Clinic/Center in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.