Organization Active NPI

Octave Healhcare Corp

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1104710151
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OCTAVE HEALHCARE CORP
Practice address
1431 N Western Ave Ste 209
Chicago, IL 60622-7712
Phone
(630) 460-7715
NPI assigned
Jun 4, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Authorized official

Name
Valerie Mayuga, MDNPI 1740697853
Title
Owner
Phone
(773) 772-7854

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1431 N Western Ave Ste 209
Chicago, IL 60622-7712

Mailing address

1S376 Summit Ave Ste 4C
Oakbrook Terrace, IL 60181-3966
Phone (630) 424-1122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250724000966 IL Part B Supplier - Clinic/Group Practice 4284140351 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1104710151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1S376 SUMMIT AVE STE 4C",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813966",
            "telephone_number": "630-424-1122",
            "fax_number": "630-324-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE STE 209",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606227712",
            "telephone_number": "630-460-7715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTAVE HEALHCARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-04",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "MAYUGA",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-772-7854",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.