Individual provider Active NPI

Maris Faye McIntyre, D.O.

  • Family Medicine Physician
  • Westmont, IL
National Provider Identifier
1063652204
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.125627 Issued in IL
Practice address
345A W Ogden Ave
Westmont, IL 60559-1419
Phone
(630) 601-3434
Fax
(331) 775-2833
NPI assigned
Feb 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

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 125050879 IL
Family Medicine Physician 207Q00000X 036.125627 IL Primary

Addresses

Primary practice location

345A W Ogden Ave
Westmont, IL 60559-1419

Mailing address

345A W Ogden Ave
Westmont, IL 60559-1419
Phone (630) 601-3434

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
I20121026000709 IL Practitioner - Family Practice 9739339771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

345 A W Ogden Ave
Westmont, IL 60559-1419
Phone (630) 205-5129

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125050879ILMDEmergency Medicine Physician
036.125627ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McIntyre Family Medicine LLC CurrentSince Oct 1, 2019 Accepting new patients
Adventist Health Partners, Inc Family Medicine Past Accepting new patients

Locations

345A W Ogden Ave
Westmont, IL 60559
Phone (630) 205-5129

Interoperability endpoints

  • Direct secure messaging: maris.mcintyre.1@20111.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/20111/brand/1/csg/1/fhir/r4

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 5

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": "1235779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1063652204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345A W OGDEN AVE",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605591419",
            "telephone_number": "630-601-3434",
            "fax_number": "331-775-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345A W OGDEN AVE",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605591419",
            "telephone_number": "630-601-3434",
            "fax_number": "331-775-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTYRE",
        "first_name": "MARIS",
        "middle_name": "FAYE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-28",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125050879",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.125627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westmont, IL

Sources for this page

Verify at the official NPI Registry.