Organization Active NPI

Dr. Angie Abdallah Ghanayem PC

  • Optometrist
  • Chicago, IL
National Provider Identifier
1154629160
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DR. ANGIE ABDALLAH GHANAYEM PC
Practice address
7146 N Harlem Ave
Chicago, IL 60631-1017
Phone
(773) 775-3937
NPI assigned
Mar 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Authorized official

Name
Dr. Angie Abdallah GhanayemNPI 1295740678
Title
Optometrist/Owner
Phone
(773) 775-3937

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X
Low Vision Rehabilitation OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WL0500X
Pediatric OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WP0200X
Sports Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WS0006X
Vision Therapy OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WV0400X
Occupational Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WX0102X

Addresses

Primary practice location

7146 N Harlem Ave
Chicago, IL 60631-1017

Mailing address

7146 N Harlem Ave
Chicago, IL 60631-1017

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110317000731 IL Part B Supplier - Clinic/Group Practice 8820271554 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": "1298937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1154629160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7146 N HARLEM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7146 N HARLEM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311017",
            "telephone_number": "773-775-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ANGIE ABDALLAH GHANAYEM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-01",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "GHANAYEM",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "ABDALLAH",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "773-775-3937",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Mar 1, 2011; 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.