NPIMap

Organization Active NPI

Chicago Pain Medicine Center

  • Interventional Pain Medicine Physician
  • Chicago, IL
National Provider Identifier
1760089718
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
CHICAGO PAIN MEDICINE CENTER
Practice address
7531 S Stony Island Ave
Chicago, IL 60649-3954
Phone
(773) 868-6824
Fax
(773) 868-6828
NPI assigned
Oct 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Authorized official

Name
James R Diesfeld, MDNPI 1497753214
Title
President
Phone
(773) 868-6824

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

7531 S Stony Island Ave
Chicago, IL 60649-3954

Mailing address

1044 N Francisco Ave Ste 404
Chicago, IL 60622-2743
Phone (773) 868-6824

Other identifiers 1

IdentifierTypeStateIssuer
036086023MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Chicago Pain Medicine Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

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": "1601596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1760089718",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7531 S STONY ISLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493954",
            "telephone_number": "773-868-6824",
            "fax_number": "773-868-6828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO PAIN MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-02",
        "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_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086023",
            "state": "IL"
        }
    ],
    "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 Oct 2, 2020; 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.