NPIMap

Organization Active NPI

Lake County Head and Neck Specialists S.C.

  • Otolaryngology Physician
  • Gurnee, IL
National Provider Identifier
1851432157
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
LAKE COUNTY HEAD AND NECK SPECIALISTS S.C.
Practice address
222 S Greenleaf St
Suite 106
Gurnee, IL 60031-5705
Phone
(847) 662-4442
Fax
(847) 662-4446
NPI assigned
Feb 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Neriz Campos
Title
Office Manager
Phone
(847) 662-4442

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

222 S Greenleaf St
Suite 106
Gurnee, IL 60031-5705

Mailing address

222 S Greenleaf St
Suite 106
Gurnee, IL 60031-5705
Phone (847) 662-4442

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071108000009 IL Part B Supplier - Clinic/Group Practice 3476640459 Receives reassigned benefits from 9 practitioners
Practice locations: Gurnee, IL; Libertyville, IL

National Provider Directory

National Provider Directory

Locations

222 S Greenleaf St
Ste 102
Gurnee, IL 60031
Phone (847) 662-4442

1105 W Park Ave
Ste 7
Libertyville, IL 60048
Phone (847) 367-5770

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851432157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE 106",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-662-4442",
            "fax_number": "847-662-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE 106",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-662-4442",
            "fax_number": "847-662-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY HEAD AND NECK SPECIALISTS S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAMPOS",
        "authorized_official_first_name": "NERIZ",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-662-4442",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.