Illinois Bone and Joint Institute, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ILLINOIS BONE AND JOINT INSTITUTE, LLC

Practice address

350 S Greenleaf St
Suite 403
Gurnee, IL 60031-5709

Phone

(847) 596-7640

NPI assigned

Sep 1, 2009

Organization subpart

No

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

Authorized official

Name

Wayne Goldstein, MD

Title

President

Phone

(847) 324-3976

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Illinois Bone and Joint Institute, LLC

  • Orthopaedic Surgery Physician
  • Gurnee, IL
  • NPI 1780743054

  O20100930080771

  Same enrollment

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

{
    "created_epoch": "1251763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1962635490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RAND RD",
            "address_2": "SUITE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162359",
            "telephone_number": "847-324-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S GREENLEAF ST",
            "address_2": "SUITE 403",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315709",
            "telephone_number": "847-596-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS BONE AND JOINT INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-01",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-324-3976",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Hutchinson Tluczek, LCSW
• Amber Ijaz, D.O.
• Illinois Bone and Joint Institute, LLC
• Illinois Bone and Joint Institute, LLC
• Illinois Bone and Joint Institute, LLC
• Illinois Bone and Joint Institute, LLC
• Illinois Pain Specialists, LLC
• Illinois Skilled Care, LLC
• Imactek, Corp
• Imperfect Harmony Counseling LTD

• Physical Therapist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.