Illinois Retina Associates PLLC

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

ILLINOIS RETINA ASSOCIATES PLLC

Doing business as

The Retina Center

Practice address

11516 183Rd PL Ste SW
Orland Park, IL 60467-9471

Phone

(708) 877-1300

NPI assigned

Jul 26, 2005

Reactivated

May 18, 2018

Last updated

Feb 4, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Frederick

Title

Billing Manager

Phone

(708) 915-6963

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• The Retina Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

Enrollment records 2

Tax ID family

Illinois Retina Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Illinois Retina Associates, S.C.

  • Medical Specialty Clinic/Center
  • Harvey, IL
  • NPI 1750765012
  NPD tax ID

Locations

Interoperability endpoints

• Direct secure messaging: hfeng@illret.intellechartdirect.net
• Direct secure messaging: jcivantos@illret.intellechartdirect.net
• Direct secure messaging: jcohen@illret.intellechartdirect.net
• Direct secure messaging: jpollack@illret.intellechartdirect.net
• Direct secure messaging: jwilgucki@illret.intellechartdirect.net
• Direct secure messaging: kelwood@illret.intellechartdirect.net
• Direct secure messaging: krezaei@illret.intellechartdirect.net
• Direct secure messaging: mmaccumber@illret.intellechartdirect.net
• Direct secure messaging: pdebustros@illret.intellechartdirect.net
• Direct secure messaging: sfard@illret.intellechartdirect.net
• Direct secure messaging: shasan@illret.intellechartdirect.net
• Direct secure messaging: sminaker@illret.intellechartdirect.net
• Direct secure messaging: vchaturvedi@illret.intellechartdirect.net
• Direct secure messaging: zravage@illret.intellechartdirect.net

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph M Civantos, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1336149053

  IN

  Medicare reassignment Care Compare group NPD
• Jack A Cohen, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1205836947
  Medicare reassignment Care Compare group NPD
• Paul Michael De Bustros

  • Retina Specialist (Ophthalmology) Physician
  • Orland Park, IL
  • NPI 1487230876

  IN

  Medicare reassignment Care Compare group NPD
• Sara Fard, MD

  • Retina Specialist (Ophthalmology) Physician
  • Orland Park, IL
  • NPI 1316508492
  Medicare reassignment Care Compare group NPD
• Henry Luyao Feng, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Chicago, IL
  • NPI 1538522834
  Medicare reassignment Care Compare group NPD
• Sohail J Hasan, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1700886439
  Medicare reassignment Care Compare group NPD
• Ramon Lee, MD

  • Retina Specialist (Ophthalmology) Physician
  • Flossmoor, IL
  • NPI 1194119339

  IN

  Medicare reassignment Care Compare group NPD
• Mathew W Maccumber, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1649270224
  Medicare reassignment Care Compare group NPD
• John S Pollack, MD

  • Retina Specialist (Ophthalmology) Physician
  • Joliet, IL
  • NPI 1881694933
  Medicare reassignment Care Compare group NPD
• Veena Rao Raiji, MD, MPH

  • Retina Specialist (Ophthalmology) Physician
  • Chicago, IL
  • NPI 1477735595
  Medicare reassignment Care Compare group NPD
• Zac B Ravage, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1992871248
  Medicare reassignment Care Compare group NPD
• Kourous A Rezaei, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1366428070

  IN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1225038870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11516 183RD PL STE SW",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604679471",
            "telephone_number": "708-877-1300",
            "fax_number": "708-596-8719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11516 183RD PL STE SW",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604679471",
            "telephone_number": "708-877-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "71 W 156th St",
            "address_2": "Ste 400",
            "address_purpose": "LOCATION",
            "city": "Harvey",
            "state": "IL",
            "postal_code": "604264265",
            "country_code": "US",
            "telephone_number": "708-596-8710",
            "fax_number": "708-596-9820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ILLINOIS RETINA ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "deactivation_date": "2018-05-16",
        "reactivation_date": "2018-05-18",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "708-915-6963"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036113707",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN0205",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN1137",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcivantos@illret.intellechartdirect.net",
            "affiliation": "N",
            "address_1": "71 W 156th St",
            "address_2": "Ste 400",
            "city": "Harvey",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604264265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Retina Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Retina Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Retina Specialist (Ophthalmology) Physician in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Retina Specialist (Ophthalmology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; 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.