Open Door Clinic

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

OPEN DOOR CLINIC

Practice address

157 S Lincoln Ave
Suite K
Aurora, IL 60505-4264

Phone

(630) 264-1819

Fax

(630) 229-0182

NPI assigned

May 19, 2015

Organization subpart

No

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

Authorized official

Name

Mr. David Roesler

Title

Executive Director

Phone

(630) 707-7704

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Open Door Clinic of Greater Elgin

  • Medical Specialty Clinic/Center
  • Elgin, IL
  • NPI 1255354635

  O20050914000576

  Same enrollment

Practitioners 3

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

• Josh Lopez

  • Family Nurse Practitioner
  • Elgin, IL
  • NPI 1184166001
  NPD
• Vivian Adeck Ndangoh-Tendong, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Aurora, IL
  • NPI 1962075473
  NPD
• Thomas Jorge Torrez

  • Family Nurse Practitioner
  • Elgin, IL
  • NPI 1902622079
  NPD

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431993600000",
    "number": "1174902555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 S LINCOLN AVE",
            "address_2": "SUITE K",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605054264",
            "telephone_number": "630-264-1819",
            "fax_number": "630-229-0182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 S LINCOLN AVE",
            "address_2": "SUITE K",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605054264",
            "telephone_number": "630-264-1819",
            "fax_number": "630-229-0182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2015-05-19",
        "status": "A",
        "authorized_official_last_name": "ROESLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-707-7704",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sana Hussain Omer, PT, DPT
• Nikki Ann Ondyak
• Kathleen Ongtangco, PT
• Francis Onimbo
• Jessica Ontiveros
• Open Door Clinic
• Taylor Opsahl
• Optima Oral Systemic Solutions LLC
• Optimal Physical Therapy and Wellness Inc
• Optimum Chiropractic Center, S.C.

• Infectious Disease Physician in Aurora, IL
• Providers in Aurora, IL by specialty
• Infectious Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; 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.