NPIMap

Organization Active NPI

Chicagoland Pain Management Institute, Inc.

  • Pain Medicine Physician
  • Bolingbrook, IL
National Provider Identifier
1801146303
Registry record updated Aug 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.
Practice address
420 S. Schmidt Road
Ste. 240
Bolingbrook, IL 60440-2634
Phone
(630) 312-4562
Fax
(630) 312-6651
NPI assigned
Sep 12, 2012
Last updated
Aug 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2019

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

Authorized official

Name
Goran Tubic, MDNPI 1417159377
Title
Sole Owner
Phone
(630) 312-4562

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
Anesthesiology Physician 207L00000X NU
Pain Medicine Physician 208VP0000X IL Primary

Addresses

Primary practice location

420 S. Schmidt Road
Ste. 240
Bolingbrook, IL 60440-2634

Mailing address

420 S. Schmidt Road
Ste. 110
Bolingbrook, IL 60440-1737
Phone (630) 312-4562

Other practice location 1

420 Remington Blvd
Bolingbrook, IL 60440-4925
Phone (630) 312-4562

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130321000540 IL Part B Supplier - Clinic/Group Practice 1850536830 Receives reassigned benefits from 13 practitioners
Practice locations: Bolingbrook, IL; Hinsdale, IL

National Provider Directory

National Provider Directory

Locations

26358 Network Pl
Chicago, IL 60673

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13549/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1801146303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S. SCHMIDT ROAD",
            "address_2": "STE. 110",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401737",
            "telephone_number": "630-312-4562",
            "fax_number": "630-312-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S. SCHMIDT ROAD",
            "address_2": "STE. 240",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402634",
            "telephone_number": "630-312-4562",
            "fax_number": "630-312-6651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Remington Blvd",
            "address_purpose": "LOCATION",
            "city": "Bolingbrook",
            "state": "IL",
            "postal_code": "604404925",
            "country_code": "US",
            "telephone_number": "630-312-4562",
            "fax_number": "630-312-6651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHICAGOLAND PAIN MANAGEMENT INSTITUTE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "TUBIC",
        "authorized_official_first_name": "GORAN",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "630-312-4562",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; 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.