NPIMap

Individual provider Active NPI

Mazen Diab, M.D.

  • Nephrology Physician
  • Tinley Park, IL
National Provider Identifier
1134436819
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036-135420 Issued in IL
Practice address
17495 La Grange Rd
Tinley Park, IL 60487-7581
Phone
(630) 873-8875
NPI assigned
Sep 2, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Toxicology (Emergency Medicine) Physician 207PT0002X MT198421 PA
Nephrology Physician 207RN0300X 036-135420 IL Primary
Internal Medicine Physician 207R00000X 036135420 IL

Addresses

Primary practice location

17495 La Grange Rd
Tinley Park, IL 60487-7581

Mailing address

1860 Payshere Cir
Chicago, IL 60674-4325
Phone (630) 469-9200

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
I20160222002768 IL Practitioner - Internal MedicinePractitioner - Nephrology 3678873114 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney and Hypertension Associates LTDGroup PAC ID 3577595545, 6 clinicians

Practice addresses (Care Compare)

8058 S Western Ave
Chicago, IL 60620-5936
Phone (708) 251-4190

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT198421PAMDMedical Toxicology (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Nov 7, 2016 Accepting new patients
Granite City Hospitalist Services LLC CurrentSince Jan 15, 2020 Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Nov 7, 2016 Accepting new patients
Kidney and Hypertension Associates LTD Nephrology CurrentSince Sep 28, 2019 Accepting new patients
Sound Physicians of Illinois, LLC Internal Medicine CurrentSince Mar 1, 2016 Accepting new patients
MD Health Group LLC Nephrology Current Accepting new patients
Hospitalist Medicine Physicians of Illinois - Rockford, LLC Internal Medicine CurrentSince Mar 1, 2020 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691

29373 Network Pl
Chicago, IL 60673

1044 N Francisco Ave
Chicago, IL 60622
Phone (773) 292-8227

8058 S Western Ave
Chicago, IL 60620
Phone (773) 778-1950

3913 W 95th St
Evergreen Pk, IL 60805
Phone (708) 229-1444

2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000

1300 Franklin Ave
Ste 380
Normal, IL 61761
Phone (309) 268-3589

4440 W 95th St
Oak Lawn, IL 60453
Phone (708) 346-5520

14640 John Humphrey Dr
Orland Park, IL 60462
Phone (708) 403-8130

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

Organizations & group practices 8

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": "1283385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1134436819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606744325",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17495 LA GRANGE RD",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604877581",
            "telephone_number": "630-873-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAB",
        "first_name": "MAZEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-02",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PT0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Medical Toxicology",
            "state": "PA",
            "license": "MT198421",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036-135420",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036135420",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

Verify at the official NPI Registry.