Active NPI
Mohin Tissa Samaraweera, MD
- Family Medicine Physician
- Plainfield, IL
National Provider Identifier
1295896173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36048836
- Practice address
- 24016 W Main Street
Plainfield, IL 60544 - Phone
- (815) 436-7303
- Fax
- (815) 609-7980
- NPI assigned
- Dec 13, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36048836 | IL | Primary |
Addresses
Primary practice location
24016 W Main Street
Plainfield, IL 60544
Mailing address
24016 W Main Street
Plainfield, IL 60544
Phone (815) 436-7303
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03L048836 | Medicaid | IL | |
| 9900490 | Other | IL | BC BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36048836 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261440000000",
"number": "1295896173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24016 W MAIN STREET",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "60544",
"telephone_number": "815-436-7303",
"fax_number": "815-609-7980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24016 W MAIN STREET",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "60544",
"telephone_number": "815-436-7303",
"fax_number": "815-609-7980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMARAWEERA",
"first_name": "MOHIN",
"middle_name": "TISSA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2009-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "36048836",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03L048836",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "9900490",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.