Organization Active NPI

LG Care PC

  • Adult Health Nurse Practitioner
  • Northbrook, IL
National Provider Identifier
1740690494
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
209.006769 Issued in IL
Legal business name
LG CARE PC
Practice address
1910 Landwehr Rd
Northbrook, IL 60062-5163
Phone
(847) 293-7375
Fax
(847) 400-0881
NPI assigned
May 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Authorized official

Name
Mr. Leon Gurvich, ANP,MS, CWSNPI 1659550374
Title
Owner
Phone
(847) 293-7375

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
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X 209.006769 IL Primary

Addresses

Primary practice location

1910 Landwehr Rd
Northbrook, IL 60062-5163

Mailing address

1910 Landwehr Rd
Northbrook, IL 60062-5163
Phone (847) 293-7375

Other identifiers 1

IdentifierTypeStateIssuer
331022542001MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140708000606 IL Part B Supplier - Clinic/Group Practice 3577788579 Receives reassigned benefits from 1 practitioner
Practice locations: Libertyville, IL; Lincolnshire, IL

National Provider Directory

National Provider Directory

Locations

2534 Elim Ave
Zion, IL 60099
Phone (847) 328-6503

Practitioners & affiliated clinicians

Practitioners 1

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": "1399075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1740690494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 LANDWEHR RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600625163",
            "telephone_number": "847-293-7375",
            "fax_number": "847-400-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 LANDWEHR RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600625163",
            "telephone_number": "847-293-7375",
            "fax_number": "847-400-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LG CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-03",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "GURVICH",
        "authorized_official_first_name": "LEON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-293-7375",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ANP,MS, CWS"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.006769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331022542001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; 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.