Oak Crest Laboratory Services, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D0418588 Issued in IL

Legal business name

OAK CREST LABORATORY SERVICES, INC

Practice address

1452 Merchant Dr Unit B
Algonquin, IL 60102-5917

Phone

(708) 634-6180

Fax

(708) 634-6181

NPI assigned

Jun 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Russell John Gambino Jr.

Title

President

Phone

(708) 567-1231

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1205876554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1452 MERCHANT DR UNIT B",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601025917",
            "telephone_number": "708-634-6180",
            "fax_number": "708-634-6181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1452 MERCHANT DR UNIT B",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601025917",
            "telephone_number": "708-634-6180",
            "fax_number": "708-634-6181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK CREST LABORATORY SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "GAMBINO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-567-1231",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D0418588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS PPO",
            "identifier": "1205876554",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1205876554",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern Illinois Medical Center
• Northwest Primary Care PC
• Northwest Pulmonary and Sleep Medicine SC
• Jillian Nuzzo
• Kelsey Kathleen O'Brien
• Morris Tunde Ogunleye
• Rebecca Oller
• Sarah Zeigler Olsen, CPNP-PC
• Catherine Ann Olson, RN, IBCLC
• Elizabeth O Omofonmwan

• Clinical Medical Laboratory in Algonquin, IL
• Providers in Algonquin, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.