Organization Active NPI

GT Plastic and Reconstructive Surgery, S.C.

  • Plastic and Reconstructive Surgery Physician
  • Elgin, IL
National Provider Identifier
1992731228
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
042-616888 Issued in IL
Legal business name
GT PLASTIC AND RECONSTRUCTIVE SURGERY, S.C.
Practice address
163 S Randall Rd
Elgin, IL 60123-5551
Phone
(847) 458-8808
Fax
(847) 458-8822
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Authorized official

Name
Gunnar Thors, MDNPI 1508893884
Title
Owner
Phone
(847) 458-8808

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X 042-616888 IL Primary

Addresses

Primary practice location

163 S Randall Rd
Elgin, IL 60123-5551

Mailing address

PO Box 410
Barrington, IL 60011-0410
Phone (847) 458-8808

Other identifiers 2

IdentifierTypeStateIssuer
04923242OtherILBLUECROSS/BLUESHIELD
132503800OtherUS DEPT OF LABOR-OWCP

Other names 1

  • Midwest Plastic Surgery Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060913000507 IL Part B Supplier - Clinic/Group Practice 7012911613 Receives reassigned benefits from 1 practitioner
Practice locations: McHenry, IL; Lake in the Hills, IL; Huntley, IL; Geneva, IL; Elgin, IL; Algonquin, IL

National Provider Directory

National Provider Directory

Locations

4900 S State Route 31
Crystal Lake, IL 60012
Phone (815) 455-3650

10400 Haligus Rd
Ofc
Huntley, IL 60142
Phone (224) 654-0000

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1992731228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600110410",
            "telephone_number": "847-458-8808",
            "fax_number": "847-458-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 S RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601235551",
            "telephone_number": "847-458-8808",
            "fax_number": "847-458-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GT PLASTIC AND RECONSTRUCTIVE SURGERY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "THORS",
        "authorized_official_first_name": "GUNNAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-458-8808",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "042-616888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "04923242",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR-OWCP",
            "identifier": "132503800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Plastic Surgery Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.