Sadoun I Omari, M.D.

Key facts

NPI

1013902121

Entity type

Individual (NPI type 1)

Primary specialty

Pediatrics Physician 208000000X

License

34155 (WI)

Practice address

12635 W. Bluemound Road
Brookfield, WI 53005-8004

Phone

(414) 258-0606

Fax

(414) 258-1953

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

No

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.

• Childrens Medical Group Inc Pediatrics Physician · Milwaukee, WI · NPI 1790732410
  Medicare reassignment NPD PEDIATRICS · WI
• Children'S Medical Group Pediatrics Physician · Glendale, WI · NPI 1134394471
  NPD (past) PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: somari12137@direct.chw.org

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 24, 2016.

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458777600000",
    "number": "1013902121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12635 W. BLUEMOUND ROAD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530058004",
            "telephone_number": "414-258-0606",
            "fax_number": "414-258-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12635 W. BLUEMOUND ROAD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530058004",
            "telephone_number": "414-258-0606",
            "fax_number": "414-258-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMARI",
        "first_name": "SADOUN",
        "middle_name": "I",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2016-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "34155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32093100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Brookfield, WI · Pediatrics Physician in Wisconsin