Crystal Lake Family Treatment Center LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036073896 Issued in IL

Legal business name

CRYSTAL LAKE FAMILY TREATMENT CENTER LTD

Practice address

185 Heritage Drive
Suite 3
Crystal Lake, IL 60014

Phone

(815) 455-0310

Fax

(815) 455-1210

NPI assigned

Apr 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John S Balocki, DO

Title

President

Phone

(815) 455-0310

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa A Walden, M.D.

  • Family Medicine Physician
  • Elgin, IL
  • NPI 1508977992
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1851353361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 HERITAGE DRIVE",
            "address_2": "SUITE 3",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-455-0310",
            "fax_number": "815-455-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 HERITAGE DRIVE",
            "address_2": "SUITE 3",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-455-0310",
            "fax_number": "815-455-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE FAMILY TREATMENT CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "BALOCKI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-455-0310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036073896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073896",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Family Dental Care
• Crystal Lake CC SCH Dist 47
• Crystal Lake Center for Chronic Pain SC
• Crystal Lake Dermatology SC
• Crystal Lake Family Dental
• Crystal Lake Family Wellness
• Crystal Lake Foot & Ankle Center LLC
• Crystal Lake Immediate Care Physicians LTD.
• Crystal Lake Medical and Sports Rehab SC
• Crystal Lake Memory Care, LLC (Autumn Leaves of Crystal Lake)

• Family Medicine Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.