Wael Mohammad Otaibi, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036150787 Issued in IL

Practice address

1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800

Phone

(217) 329-1000

Fax

(217) 329-1055

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wotaibi162453@direct.covenanthealthcare.com

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.

• Marlette Regional Hospital

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• Marlette Regional Hospital

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• Marlette Regional Hospital

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• Marlette Regional Hospital

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  NPD
• Marlette Regional Hospital

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  • Marlette, MI
  • NPI 1730988999
  NPD
• HSHS Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, IL
  • NPI 1629465414
  NPD (past)
• MVC Az

  • Surgery Physician
  • Phoenix, AZ
  • NPI 1477256063
  NPD (past)
• MVC CT

  • Surgery Physician
  • Stamford, CT
  • NPI 1487397600
  NPD (past)

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1255452124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 HOLLIS DR FL 2",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047452",
            "telephone_number": "217-523-5432",
            "fax_number": "217-492-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 E LAKE SHORE DR STE 105",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213800",
            "telephone_number": "217-329-1000",
            "fax_number": "217-329-1055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207 S Pine St",
            "address_purpose": "LOCATION",
            "city": "Shelbyville",
            "state": "IL",
            "postal_code": "625651749",
            "country_code": "US",
            "telephone_number": "217-464-1200",
            "fax_number": "217-464-1210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Isaac Streets Dr",
            "address_2": "Suite 134",
            "address_purpose": "LOCATION",
            "city": "Oregon",
            "state": "OH",
            "postal_code": "436163291",
            "country_code": "US",
            "telephone_number": "419-720-2242",
            "fax_number": "419-720-2897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTAIBI",
        "first_name": "WAEL",
        "middle_name": "MOHAMMAD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "254927",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101015634",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "34.011232",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036150787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.