Organization Active NPI

Pacific Vein Care, LLC

  • Vascular & Interventional Radiology Physician
  • McHenry, IL
National Provider Identifier
1649405200
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
PACIFIC VEIN CARE, LLC
Practice address
3929 Mercy Dr
McHenry, IL 60050-3151
Phone
(815) 759-2368
Fax
(815) 759-2367
NPI assigned
May 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

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

Authorized official

Name
Dr. Ernest A Conti, M.D.NPI 1033133426
Title
Lead Physician
Phone
(815) 759-0800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

3929 Mercy Dr
McHenry, IL 60050-3151

Mailing address

3929 Mercy Dr
McHenry, IL 60050-3151
Phone (815) 759-2368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090914000343 IL Part B Supplier - Clinic/Group Practice 2961558101 Receives reassigned benefits from 6 practitioners
Practice locations: Cary, IL

National Provider Directory

National Provider Directory

Locations

445 Park Ave
Ste P
Cary, IL 60013
Phone (815) 236-8907

10350 Haligus Rd
#201
Huntley, IL 60142
Phone (847) 802-7881

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1649405200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3929 MERCY DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600503151",
            "telephone_number": "815-759-2368",
            "fax_number": "815-759-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 MERCY DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600503151",
            "telephone_number": "815-759-2368",
            "fax_number": "815-759-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VEIN CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "CONTI",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LEAD PHYSICIAN",
        "authorized_official_telephone_number": "815-759-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; 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.