Individual provider Active NPI

Patricia M O'Donnell, DPM

  • Podiatrist
  • Glen Ellyn, IL
National Provider Identifier
1013047190
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
0016004785 Issued in IL
Practice address
885 Roosevelt Rd
Glen Ellyn, IL 60137-6141
Phone
(630) 225-2663
Fax
(630) 225-2399
NPI assigned
Mar 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 0016004785 IL Primary

Addresses

Primary practice location

885 Roosevelt Rd
Glen Ellyn, IL 60137-6141

Mailing address

885 Roosevelt Rd
Glen Ellyn, IL 60137-6141
Phone (630) 225-2663

Other identifiers 3

IdentifierTypeStateIssuer
206147OtherILMEDICARE PTAN (GROUP)
016004785OtherILMEDICAID
F400181111OtherILMEDICARE PTAN (INDIVIDUAL)

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080123000130 IL Practitioner - Podiatry 4880775360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

10 E
75TH
Naperville, IL 60565-1469
Phone (630) 225-2663

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue40
Removal of nail tissue11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0016004785ILMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Dec 1, 2014 Accepting new patients
Central Dupage Physician Group CurrentSince Dec 1, 2014 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

885 Roosevelt Rd
Glen Ellyn, IL 60137
Phone (630) 545-3760

101 E 75th St
Ste 100
Naperville, IL 60565

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1013047190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376141",
            "telephone_number": "630-225-2663",
            "fax_number": "630-225-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376141",
            "telephone_number": "630-225-2663",
            "fax_number": "630-225-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "PATRICIA",
        "middle_name": "M",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "0016004785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (GROUP)",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "016004785",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "F400181111",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

Verify at the official NPI Registry.