NPIMap

Organization Active NPI

Great Lake Pain Physicians LTD.

  • Pain Medicine (Anesthesiology) Physician
  • Gurnee, IL
National Provider Identifier
1902016561
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
036-084312 Issued in IL
Legal business name
GREAT LAKE PAIN PHYSICIANS LTD.
Practice address
15 Tower CT
Ste # 190
Gurnee, IL 60031-3336
Phone
(847) 970-0885
NPI assigned
May 23, 2007
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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

Authorized official

Name
Dr. Eliza Diaconescu, M.D.NPI 1881655140
Title
Medical Director
Phone
(847) 970-0885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 036-084312 IL Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 036-084312 IL
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 036-084312 IL
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 036-084312 IL

Addresses

Primary practice location

15 Tower CT
Ste # 190
Gurnee, IL 60031-3336

Mailing address

15 Tower CT
Ste # 190
Gurnee, IL 60031-3336
Phone (847) 970-0885

National Provider Directory

National Provider Directory

Locations

15 Tower Ct
Ste 190
Gurnee, IL 60031
Phone (847) 263-8388

Practitioners & affiliated clinicians

Practitioners 1

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1902016561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 TOWER CT",
            "address_2": "STE # 190",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313336",
            "telephone_number": "847-970-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 TOWER CT",
            "address_2": "STE # 190",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313336",
            "telephone_number": "847-970-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKE PAIN PHYSICIANS LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "DIACONESCU",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "18479700885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        }
    ],
    "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 Nov 25, 2014; 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.