NPIMap

Organization Active NPI

Premiercare Anesthesia & Pain P.C.

  • Anesthesiology Physician
  • Chicago, IL
National Provider Identifier
1649696147
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036.087570 Issued in IL
Legal business name
PREMIERCARE ANESTHESIA & PAIN P.C.
Practice address
3407 W Fullerton Ave
Chicago, IL 60647-2497
Phone
(312) 475-1203
Fax
(312) 929-3739
NPI assigned
Mar 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2016

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

Authorized official

Name
Dr. Daniel Maksimovich, M.D.
Title
President
Phone
(630) 400-4881

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X 036.087570 IL Primary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207LP2900X 036.087570 IL

Addresses

Primary practice location

3407 W Fullerton Ave
Chicago, IL 60647-2497

Mailing address

200 W Menomonee St
Unit 4
Chicago, IL 60614-5313
Phone (630) 400-4881

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1394323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452643200000",
    "number": "1649696147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W MENOMONEE ST",
            "address_2": "UNIT 4",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606145313",
            "telephone_number": "630-400-4881",
            "fax_number": "312-929-3739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3407 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472497",
            "telephone_number": "312-475-1203",
            "fax_number": "312-929-3739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERCARE ANESTHESIA & PAIN P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-09",
        "last_updated": "2016-01-13",
        "status": "A",
        "authorized_official_last_name": "MAKSIMOVICH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-400-4881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036.087570",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036.087570",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2016; 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.