Chicago Pain Medicine Center

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

036.086023 Issued in IL

Legal business name

CHICAGO PAIN MEDICINE CENTER

Practice address

1044 N Francisco Ave Ste 404
Chicago, IL 60622-2743

Phone

(773) 868-6824

Fax

(773) 868-6828

NPI assigned

May 31, 2006

Last updated

Oct 2, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James R. Diesfeld, M.D.NPI 1497753214

Title

President

Phone

(773) 868-6824

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

Locations

Practitioners 5

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.

• James R Diesfeld, M.D.

  • Interventional Pain Medicine Physician
  • Chicago, IL
  • NPI 1497753214
  Medicare reassignment NPD Authorized official
• Lashawnna Chanel Jackson

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1225790447

  Durable Medical Equipment & Medical Supplies

  Medicare reassignment NPD
• Christina Handayan, PA

  • Physician Assistant
  • Schaumburg, IL
  • NPI 1346023504
  Medicare reassignment
• Brandy Lynn Hanson, FNP-BC

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1467945840

  Multi-Specialty

  NPD (past)
• Yolanda Peraza Zaragoza-Diesfeld, L.C.S.W.

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1184804627
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1669429890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N FRANCISCO AVE STE 404",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222743",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N FRANCISCO AVE STE 404",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222743",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6307 S Stewart Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606213116",
            "country_code": "US",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5215 N California Ave Ste F717",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606258562",
            "country_code": "US",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8012 S Crandon Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606171124",
            "country_code": "US",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7531 S Stony Island Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606493954",
            "country_code": "US",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHICAGO PAIN MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "DIESFELD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-868-6824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036.086023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ILLINOIS",
            "identifier": "01605512",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086023",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chicago Pain LLC
• Chicago Pain Medicine Center
• Chicago Pain Medicine Center
• Chicago Pain Medicine Center
• Chicago Pain Medicine Center
• Chicago Pain Medicine Center
• Chicago Pain Medicine Center
• Chicago PCR Lab Services Inc
• Chicago Pediatric & Neonatology SC
• Chicago Pediatric Clinic

• Interventional Pain Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Interventional Pain Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.