Individual provider Active NPI

Angie Abdallah Ghanayem, O.D.

  • Optometrist
  • Chicago, IL
National Provider Identifier
1295740678
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T-187-TA-721 Issued in AL
Practice address
7146 N Harlem Ave
Chicago, IL 60631-1017
Phone
(773) 775-3937
Fax
(773) 775-3939
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T-187-TA-721 AL Primary

Addresses

Primary practice location

7146 N Harlem Ave
Chicago, IL 60631-1017

Mailing address

7146 N Harlem Ave
Chicago, IL 60631-1017
Phone (773) 775-3937

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070829000062 IL Practitioner - Optometry 9032119029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7146 N Harlem Ave
Chicago, IL 60631-1017
Phone (773) 775-3937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T-187-TA-721ALMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Buy Contact Lenses LLC Optometrist PastSince Jun 8, 2023 Accepting new patients
Illinois College of Optometry Optometrist Past Accepting new patients
Glenview Vision Care LLC Optometrist PastSince Apr 12, 2020 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308268800000",
    "number": "1295740678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7146 N HARLEM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311017",
            "telephone_number": "773-775-3937",
            "fax_number": "773-775-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7146 N HARLEM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311017",
            "telephone_number": "773-775-3937",
            "fax_number": "773-775-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANAYEM",
        "first_name": "ANGIE",
        "middle_name": "ABDALLAH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2011-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "T-187-TA-721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.