OrganizationActive
Fairbanks, LLC
NPI 1619476405 · Specialist · Long Grove, IL
Provider details
- NPI number
- 1619476405
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Lisa Carnes, Principal(312) 450-6382
Specialties & taxonomies
Other Service Providers
Profile Score
Established profile(68/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3880 Salem Lake Dr Ste a
Long Grove, IL 60047-5292
Phone: (312) 321-1225
Street-level locationGet directions
Mailing address
3880 Salem Lake Dr Ste a
Long Grove, IL 60047-5292
Registry dates
- Enumerated
- 2018-02-07
- Last updated
- 2018-02-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.