NPIMap

Organization Active NPI

Doctors of Emergency Medicine of Illinois III, LLC

  • Hospitalist Physician
  • Meadville, PA
National Provider Identifier
1245081322
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
DOCTORS OF EMERGENCY MEDICINE OF ILLINOIS III, LLC
Practice address
751 Liberty St
Meadville, PA 16335-2559
Phone
(814) 373-2310
NPI assigned
Mar 28, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Authorized official

Name
Andrew Oleksyn, MD
Title
Authorized Official
Phone
(405) 696-7932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

751 Liberty St
Meadville, PA 16335-2559

Mailing address

PO Box 736227
Chicago, IL 60673-6227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240806002117 PA Part B Supplier - Clinic/Group Practice 4789121989 Receives reassigned benefits from 36 practitioners
Practice locations: Meadville, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1245081322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 736227",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606736227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 LIBERTY ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352559",
            "telephone_number": "814-373-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS OF EMERGENCY MEDICINE OF ILLINOIS III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "OLEKSYN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "405-696-7932",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meadville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.