Charles Loren Obrien III, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036057256 Issued in IL

Practice address

49 S Waukegan Rd Ste 100
Deerfield, IL 60015-5204

Phone

(847) 945-4575

Fax

(847) 945-4593

NPI assigned

Jul 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cobrien565@direct.northshore.org

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.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  Pediatrics

  Medicare reassignment NPD
• Levy & Obrien

  • Pediatrics Physician
  • Deerfield, IL
  • NPI 1598794422
  NPD (past) Authorized official
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1124050182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 S WAUKEGAN RD STE 100",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600155204",
            "telephone_number": "847-945-4575",
            "fax_number": "847-945-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 S WAUKEGAN RD STE 100",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600155204",
            "telephone_number": "847-945-4575",
            "fax_number": "847-945-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBRIEN",
        "first_name": "CHARLES",
        "middle_name": "LOREN",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036057256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cobrien565@direct.northshore.org",
            "affiliation": "N",
            "address_1": "400 Lake Cook Road",
            "address_2": "Suite 119",
            "city": "Deerfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nutrition Con Sazon
• Sara O'Keefe
• Amanda O'Malley, RBT
• Anna Liza O'Neal, MS
• Agnieszka Alicja Oborski
• Dawn Marie Ofilanda
• Akorede Oladigbo
• Valdo Peter Oleari II, DDS
• Israel David Oler, PH.D.
• Mary Oler

• Pediatrics Physician in Deerfield, IL
• Providers in Deerfield, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.