Advanced Orthopedic and Spine Care SC
Organization Active NPI Orthopaedic Surgery Physician · Tinley Park, IL
NPI 1013269547 · NPPES record last updated Apr 27, 2021
Key facts
- NPI
- 1013269547
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- ADVANCED ORTHOPEDIC AND SPINE CARE SC
- Practice address
- 16255 S. Harlem Ave
Tinley Park, IL 60477 - Phone
- (708) 599-5000
- Fax
- (708) 599-0801
- NPI assigned
- Oct 8, 2012
- Organization subpart
- No
Authorized official
- Name
- Daniel Troy, MD
- Title
- Director
- Phone
- (708) 599-5000
Practitioners 13
-
Dana Berns, DPM
-
Serafin Deleon, MD
-
Amanie Kahok, APRN
-
Donald E Roland, MD
-
Hannah Grace Henrichsen, PA-C
-
Adam Mietus, PA-C
-
Khaled Almansoori, MD, M.ED, MBBCH
-
Jill Stulga, MPT
-
Edward Michael Stakenas, P.T.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2339377 | Advanced Orthopedic & Spine Care, S C | Certificate of waiver | Mar 1, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121119000345 | IL | Part B Supplier - Clinic/Group Practice | 4789835836 |
Receives reassigned benefits from 9 practitioners Practice locations: Hazel Crest, IL; Kankakee, IL; Mokena, IL; Oak Lawn, IL; Palos Heights, IL; Tinley Park, IL |
| O20130314000116 | IL | DME Supplier - Physician - Orthopedic/Orthopedic Surgery |
4789835836 | Practice locations: Oak Lawn, IL |
National Provider Directory
Locations
16255 Harlem Ave
Tinley Park, IL 60477
Phone (708) 599-5000
Interoperability endpoints
- a.mietus@direct.advancedorthospine.com
- k.oliversen@direct.advancedorthospine.com
- p.danielsky@direct.advancedorthospine.com
- j.watson@direct.advancedorthospine.com
- j.perezsanz@direct.advancedorthospine.com
- d.troy@direct.advancedorthospine.com
- t.schub@direct.advancedorthospine.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Orthopaedic Surgery of the Spine Physician |
207XS0117X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Customized Equipment (DME) | 332BC3200X |
Addresses
Primary practice location
16255 S. Harlem Ave
Tinley Park, IL 60477
Mailing address
PO Box 825
Bedford Park, IL 60499-0825
Phone (708) 599-5000
Other providers in Tinley Park, IL
- Mallak Adawi
- Katherine F Addison
- Oluyemisi Oludoyin Adebayo
- Adjusted HP, PLLC
- Mariya Adlington
- Advocate Health Care
- Advocate Southwest Ambulatory Surgery Center LLC
- Advocate Southwest Ambulatory Surgery Center LLC
- Aegis Ambulatory Anesthesia, LTD
- Mohanad Ziad Affaneh
All providers in Tinley Park, IL · Orthopaedic Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.