Individual provider Active NPI

Patrick J Camodeca, DO

  • Family Medicine Physician
  • Huntley, IL
National Provider Identifier
1013915248
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036080930 Issued in IL
Practice address
10350 Haligus Rd
Huntley, IL 60142
Phone
(815) 338-6600
Fax
(847) 802-7112
NPI assigned
Jul 12, 2005
Last updated
Oct 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036080930 IL
Family Medicine Physician 207Q00000X 036080930 IL Primary

Addresses

Primary practice location

10350 Haligus Rd
Huntley, IL 60142

Mailing address

10350 Haligus Rd
Huntley, IL 60142-9545
Phone (815) 338-6600

Other practice location 1

11650 S Il Route 47
Huntley, IL 60142-9613
Phone (847) 802-7300

Other practice location 2

360 Station Dr
Crystal Lake, IL 60014-7978
Phone (815) 338-6600

Other practice location 3

2507 N Richmond Rd
McHenry, IL 60051-5407
Phone (815) 338-6600

Other practice location 4

1925 Huntley Rd
West Dundee, IL 60118-9301
Phone (815) 338-6600

Other practice location 5

2507 N Richmond Rd
McHenry, IL 60051-5407
Phone (847) 802-7300

Other identifiers 3

IdentifierTypeStateIssuer
04532206OtherILBLUE CROSS BLUE SHIELD
036080930OtherILSTATE LICENSE
036080930MedicaidIL

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040211000624 IL Practitioner - Family Practice 5395639256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Osteopathy, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

3707 Doty Rd
Woodstock, IL 60098-7530

4309 W Medical Ctr Dr
Suite A200
McHenry, IL 60050-8437
Phone (815) 759-8070

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

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 tissue858
Removal of skin lesions59
Skin biopsy30

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036080930ILMDFamily Medicine Physician
036067282ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Family Medicine CurrentSince May 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2019 Accepting new patients
Central Dupage Physician Group CurrentSince May 1, 2019 Accepting new patients

Locations

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

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

Dept 5777
Carol Stream, IL 60122

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

360 Station Dr
Crystal Lake, IL 60014
Phone (815) 477-7350

10350 Haligus Rd
Huntley, IL 60142
Phone (847) 802-7150

11650 S State Route 47
Huntley, IL 60142
Phone (847) 802-7300

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

2507 N Richmond Rd
McHenry, IL 60051
Phone (815) 363-2350

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

1925 Huntley Rd
West Dundee, IL 60118
Phone (847) 854-3421

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

Organizations & group practices 4

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

Hospital & facility affiliations 7

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": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1013915248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 HALIGUS RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429545",
            "telephone_number": "815-338-6600",
            "fax_number": "847-802-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10350 HALIGUS RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "60142",
            "telephone_number": "815-338-6600",
            "fax_number": "847-802-7112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11650 S Il Route 47",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429613",
            "country_code": "US",
            "telephone_number": "847-802-7300",
            "fax_number": "847-668-2647",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Station Dr",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600147978",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-455-8044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2507 N Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600515407",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-385-3255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1925 Huntley Rd",
            "address_purpose": "LOCATION",
            "city": "West Dundee",
            "state": "IL",
            "postal_code": "601189301",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "847-426-5162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2507 N Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600515407",
            "country_code": "US",
            "telephone_number": "847-802-7300",
            "fax_number": "847-668-2647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMODECA",
        "first_name": "PATRICK",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036080930",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036080930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04532206",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036080930",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036080930",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntley, IL

Sources for this page

Verify at the official NPI Registry.