NPIMap

Organization Active NPI

Disomma Foot & Ankle Clinic PC

  • Podiatrist
  • Oak Park, IL
National Provider Identifier
1285621235
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
060007223 Issued in IL
Legal business name
DISOMMA FOOT & ANKLE CLINIC PC
Practice address
1100 Lake St
Ste 248
Oak Park, IL 60301-1015
Phone
(708) 383-5554
Fax
(708) 383-9321
NPI assigned
Oct 4, 2005
Last updated
Jul 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Authorized official

Name
Dr. Mary M Disomma, DPMNPI 1396806840
Title
President
Phone
(708) 383-5554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 060007223 IL Primary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 016004585 IL

Addresses

Primary practice location

1100 Lake St
Ste 248
Oak Park, IL 60301-1015

Mailing address

1100 Lake St
Ste 248
Oak Park, IL 60301-1015
Phone (708) 383-5554

Other identifiers 1

IdentifierTypeStateIssuer
016004585MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1285621235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LAKE ST",
            "address_2": "STE 248",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011015",
            "telephone_number": "708-383-5554",
            "fax_number": "708-383-9321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LAKE ST",
            "address_2": "STE 248",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011015",
            "telephone_number": "708-383-5554",
            "fax_number": "708-383-9321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISOMMA FOOT & ANKLE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "DISOMMA",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-383-5554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "060007223",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016004585",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004585",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.