Individual provider Active NPI

Myint S Oo, MD

  • Pediatrics Physician
  • Bourbonnais, IL
National Provider Identifier
1215940143
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036095943 Issued in IL
Practice address
370 Larry Power Rd
Suite 1
Bourbonnais, IL 60914-5194
Phone
(815) 937-3515
Fax
(815) 935-4916
NPI assigned
Aug 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036095943 IL Primary

Addresses

Primary practice location

370 Larry Power Rd
Suite 1
Bourbonnais, IL 60914-5194

Mailing address

370 Larry Power Rd
Suite 1
Bourbonnais, IL 60914-5194
Phone (815) 937-3515

Other identifiers 1

IdentifierTypeStateIssuer
036095943MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20140321000722 IL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 1254238603

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Internal Medicine, S.C. Past Accepting new patients
Abc Pediatrics of Kankakee County Pediatrics Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1215940143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 LARRY POWER RD",
            "address_2": "SUITE 1",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145194",
            "telephone_number": "815-937-3515",
            "fax_number": "815-935-4916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 LARRY POWER RD",
            "address_2": "SUITE 1",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145194",
            "telephone_number": "815-937-3515",
            "fax_number": "815-935-4916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OO",
        "first_name": "MYINT",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036095943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095943",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.