Active NPI
Ibrahim Dare Omore, M.D
- Hematology & Oncology Physician
- Carterville, IL
National Provider Identifier
1245896034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 036172695
- Practice address
- 1400 Pin Oak Dr
Carterville, IL 62918-1600 - Phone
- (618) 985-3333
- Fax
- (618) 985-1318
- NPI assigned
- May 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Hematology & Oncology Physician | 207RH0003X | 036172695 | IL | Primary |
Addresses
Primary practice location
1400 Pin Oak Dr
Carterville, IL 62918-1600
Mailing address
PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200
Other practice location 1
506 Lenox Avenue
Rm. 13-106-MLK
New York, NY 10037
Phone (212) 939-1000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | iomore77251@sih.direct-ci.com |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hematology/Oncology
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1400 Pin Oak Dr
Carterville, IL 62918-1600
Phone (618) 985-3333
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036172695 | IL | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Medical Services, NFP | Current | Accepting new patients |
Locations
2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300
1400 Pin Oak Dr
Carterville, IL 62918
Phone (618) 529-3159
Interoperability endpoints
- iomore77251@sih.direct-ci.com
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Carbondale, IL
- NPI 1770656837
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Harrisburg, IL
- NPI 1073580130
-
- Community Based Hospice Care Agency
- Belleville, IL
- NPI 1720081805
-
- General Acute Care Hospital
- Carbondale, IL
- NPI 1093801797
-
- Critical Access Hospital
- Murphysboro, IL
- NPI 1356435135
-
- General Acute Care Hospital
- Herrin, IL
- NPI 1528158573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754524800000",
"number": "1245896034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3988",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629023988",
"telephone_number": "618-457-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 PIN OAK DR",
"city": "CARTERVILLE",
"state": "IL",
"postal_code": "629181600",
"telephone_number": "618-985-3333",
"fax_number": "618-985-1318"
}
],
"practiceLocations": [
{
"address_1": "506 Lenox Avenue",
"address_2": "Rm. 13-106-MLK",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "10037",
"country_code": "US",
"telephone_number": "212-939-1000",
"fax_number": "212-939-1462",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OMORE",
"first_name": "IBRAHIM",
"middle_name": "DARE",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-16",
"last_updated": "2025-08-07",
"certification_date": "2025-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "IL",
"license": "036172695",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "iomore77251@sih.direct-ci.com",
"affiliation": "N",
"address_1": "1400 Pin Oak Dr",
"city": "Carterville",
"state": "IL",
"country_code": "US",
"postal_code": "629181600",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Carterville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.