Gary L Koehn, MD, PHD

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

036074138 Issued in IL

Practice address

5201 Willow Springs Rd
Suite 110
La Grange Highlands, IL 60525-6537

Phone

(708) 482-4500

Fax

(708) 482-4502

NPI assigned

May 18, 2006

Last updated

Nov 8, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1992758965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 WILLOW SPRINGS RD",
            "address_2": "SUITE 110",
            "city": "LA GRANGE HIGHLANDS",
            "state": "IL",
            "postal_code": "605256537",
            "telephone_number": "708-482-4500",
            "fax_number": "708-482-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 WILLOW SPRINGS RD",
            "address_2": "SUITE 110",
            "city": "LA GRANGE HIGHLANDS",
            "state": "IL",
            "postal_code": "605256537",
            "telephone_number": "708-482-4500",
            "fax_number": "708-482-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEHN",
        "first_name": "GARY",
        "middle_name": "L",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "25969",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036074138",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036074138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GL KOEHN ASSOC GROUP NPI",
            "identifier": "1164451308",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NO.",
            "identifier": "01608719",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE ID",
            "identifier": "030038",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR GROUP",
            "identifier": "132321800",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stuart A Issleib, MD
• Courtney Jarva
• Robert Casper Johnson
• Kenneth Kessler, PH.D., MSCP
• Kleinmeyer Physical Therapy and Rehab Specialists
• Katherine Ann Kozerski
• La Grange Women's Clinic SC
• Melanie C. Lachman, M.D.
• Lagrange Highlands SD 106
• Joanna M Lee

• Interventional Pain Medicine Physician in La Grange Highlands, IL
• Providers in La Grange Highlands, IL by specialty
• Interventional Pain Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.