Individual provider Active NPI

Gregory Gruener, MD

  • Neurology Physician
  • Maywood, IL
National Provider Identifier
1689640138
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
36064200 Issued in IL
Practice address
2160 S 1St Ave
Maguire Center, RM. 2700
Maywood, IL 60153
Phone
(708) 216-2662
Fax
(708) 216-5617
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology Physician 2084N0600X 36064200 IL
Neurology Physician 2084N0400X 36064200 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maguire Center, RM. 2700
Maywood, IL 60153

Mailing address

2160 S 1St Ave
Maguire Center, RM. 2700
Maywood, IL 60153
Phone (708) 216-2662

Other identifiers 1

IdentifierTypeStateIssuer
36064200MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ggruener12422@direct.luhs.org Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050729000096 IL Practitioner - Neurology 3476581679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Loyola University of Chicago, Stritch School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2160 S 1St Ave
Maywood, IL 60153-3328

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36064200ILMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Jan 1, 2009 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Loyola University Medical Center CurrentSince Jan 1, 2009 Accepting new patients
Loyola University Physician Foundation Past Accepting new patients

Locations

420 W Butterfield Rd
Elmhurst, IL 60126
Phone (630) 832-2300

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

2160 S 1st Ave
Rm 2700
Maywood, IL 60153
Phone (708) 327-2700

2160 S 1st Ave
Bldg 105
Maywood, IL 60153
Phone (708) 216-1676

5666 E State St
Rockford, IL 61108
Phone (815) 226-2000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1689640138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "MAGUIRE CENTER, RM. 2700",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-2662",
            "fax_number": "708-216-5617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "MAGUIRE CENTER, RM. 2700",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-2662",
            "fax_number": "708-216-5617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUENER",
        "first_name": "GREGORY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "IL",
            "license": "36064200",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "36064200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36064200",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ggruener12422@direct.luhs.org",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2160 S 1st Ave",
            "address_2": "MAGUIRE CENTER, RM. 2700",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.