Individual provider Active NPI

Michael Kevin O'Donoghue, M.D.

  • Dermatology Physician
  • Westchester, IL
National Provider Identifier
1194748962
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
03-113995 Issued in IL
Practice address
2434 Wolf Rd
Westchester, IL 60154-5634
Phone
(708) 562-5430
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 03-113995 IL Primary

Addresses

Primary practice location

2434 Wolf Rd
Westchester, IL 60154-5634

Mailing address

2434 Wolf Rd
Westchester, IL 60154-5634
Phone (708) 562-5430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20061218000344 IL Practitioner - Dermatology 4587663695 Reassigns benefits to 1 organization
I20070627000236 IN Practitioner - Dermatology 4587663695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Rush Medical College of Rush University, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Dermatology Institute, LLCGroup PAC ID 7911043054, 51 clinicians

Practice addresses (Care Compare)

1550 N Northwest Hwy
Suite 300
Park Ridge, IL 60068-1475
Phone (847) 298-1831

1550 S Woodland Ave
Michigan City, IN 46360-7125
Phone (219) 878-5020

3190 Lancer St
Portage, IN 46368-4488
Phone (219) 764-3600

Hospital & facility affiliations

  • Franciscan Health Michigan City Hospital, Michigan City, IN, CCN 150015

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions2380
Removal or shaving of skin growth85
Skin biopsy297

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03-113995ILMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Dermpath Laboratory PastSince Oct 1, 2009 Accepting new patients
Northern Indiana Dermatology and Skin Surgery Center Past Accepting new patients

Organizations & group practices 3

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 2

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1194748962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2434 WOLF RD",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601545634",
            "telephone_number": "708-562-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2434 WOLF RD",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601545634",
            "telephone_number": "708-562-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DONOGHUE",
        "first_name": "MICHAEL",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "03-113995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westchester, IL

Sources for this page

Verify at the official NPI Registry.