NPIMap

Individual provider Active NPI

Benjamin Domb, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Des Plaines, IL
National Provider Identifier
1154454635
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
036119758 Issued in IL
Practice address
999 E Touhy Ave Ste 450
Des Plaines, IL 60018-2748
Phone
(630) 920-2323
Fax
(630) 323-5625
NPI assigned
Mar 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 036119758 IL Primary

Addresses

Primary practice location

999 E Touhy Ave Ste 450
Des Plaines, IL 60018-2748

Mailing address

999 E Touhy Ave
Ste 450
Des Plaines, IL 60018-2748
Phone (630) 920-2323

Other practice location 1

1010 Executive Dr
Suite 250
Westmont, IL 60559-6135
Phone (630) 920-2350

Other identifiers 1

IdentifierTypeStateIssuer
036119758MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bdomb252075@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN, WI3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20080110000209 IL Practitioner - Orthopedic Surgery 9032299458 Reassigns benefits to 1 organization
I20160127001515 IN Practitioner - Orthopedic Surgery 9032299458 Reassigns benefits to 1 organization
I20210414002701 WI Practitioner - Orthopedic Surgery 9032299458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Johns Hopkins University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rci (WRS) LLCGroup PAC ID 5092624510, 325 clinicians
American Hip Institute LLCGroup PAC ID 9335488063, 16 clinicians

Practice addresses (Care Compare)

1300 Lincolnway
Valparaiso, IN 46383-5824

8400 Lakeview Pkwy
Suite 800
Pleasant Prairie, WI 53158-5819
Phone (833) 872-4477

9615 Keilman St
Saint John, IN 46373-9406
Phone (630) 920-2323

999 E Touhy Ave
Suite 450
Des Plaines, IL 60018-2748
Phone (630) 920-2323

Hospital & facility affiliations

  • Aspire Home Healthcare, LLC Home health agency, Morton Grove, IL, CCN 148139
  • Northwest Community Hospital 1 Hospital, Arlington Heights, IL, CCN 140252
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • St Alexius Medical Center Hospital, Hoffman Estates, IL, CCN 140290

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement23
Lower limb (leg) arthroscopy (minimally invasive joint repair)13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036119758ILMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Hip Institute, LLC Sports Medicine CurrentSince Feb 1, 2019 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Hinsdale Orthopaedic Associates, S.C. PastSince Dec 7, 2015 Accepting new patients

Locations

5505 N Cumberland Ave
Ste 307
Chicago, IL 60656
Phone (908) 441-8887

999 E Touhy Ave
Ste 450
Des Plaines, IL 60018
Phone (630) 920-2323

9615 Keilman St
Saint John, IN 46373
Phone (219) 365-0220

8400 Lakeview Pkwy
Ste 800
Pleasant Prairie, WI 53158
Phone (262) 455-7548

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 6

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": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1154454635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 E TOUHY AVE",
            "address_2": "STE 450",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600182748",
            "telephone_number": "630-920-2323",
            "fax_number": "630-323-5625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 E TOUHY AVE STE 450",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600182748",
            "telephone_number": "630-920-2323",
            "fax_number": "630-323-5625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Executive Dr",
            "address_2": "Suite 250",
            "address_purpose": "LOCATION",
            "city": "Westmont",
            "state": "IL",
            "postal_code": "605596135",
            "country_code": "US",
            "telephone_number": "630-920-2350",
            "fax_number": "630-920-2381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMB",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IL",
            "license": "036119758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036119758",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdomb252075@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "999 E Touhy Ave Ste 450",
            "city": "Des Plaines",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600182748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "999 E Touhy Ave Ste 450",
            "city": "Des Plaines",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600182748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

Verify at the official NPI Registry.