NPIMap

Individual provider Active NPI

Brian Casaclang, D.O.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1093740490
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Practice address
2400 N Sheffield Ave
Chicago, IL 60614-2215
Phone
(773) 880-0320
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

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

Addresses

Primary practice location

2400 N Sheffield Ave
Chicago, IL 60614-2215

Mailing address

2311 W 22ND St
Suite 202
Oak Brook, IL 60523-1225
Phone (630) 320-1160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100109000255 IL Practitioner - Family Practice 1850432006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6150 Joliet Rd
Countryside, IL 60525-3956
Phone (708) 485-2273

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-094084ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premise Health of Illinois Medical PC CurrentSince Jul 5, 2017 Accepting new patients
Premise Health of Illinois Medical PC Current Accepting new patients
Premise Health of Illinois Medical PC CurrentSince Jul 5, 2017 Accepting new patients
Connecticut General Life Insurance Company Past Accepting new patients

Locations

16906 Collection Ctr Dr
Chicago, IL 60693

6150 Joliet Rd
Countryside, IL 60525
Phone (708) 485-2273

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093740490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 W 22ND ST",
            "address_2": "SUITE 202",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231225",
            "telephone_number": "630-320-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N SHEFFIELD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142215",
            "telephone_number": "773-880-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASACLANG",
        "first_name": "BRIAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.