Active NPI
Omar Eassa Fakhoury, DO
- Internal Medicine Physician
- McHenry, IL
National Provider Identifier
1306536149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125082900
- Practice address
- 4201 W Medical Center Dr
McHenry, IL 60050-8409 - Phone
- (815) 344-5000
- NPI assigned
- May 15, 2023
- 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 | |||
| Internal Medicine Physician | 207R00000X | 125082900 | IL | Primary |
Addresses
Primary practice location
4201 W Medical Center Dr
McHenry, IL 60050-8409
Mailing address
4201 W Medical Center Dr
McHenry, IL 60050-8409
Phone (815) 344-5000
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231221000189 | IL | Order and Referring Only - Internal Medicine | 3870943574 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689120000000",
"number": "1306536149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 W MEDICAL CENTER DR",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600508409",
"telephone_number": "815-344-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 W MEDICAL CENTER DR",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600508409",
"telephone_number": "815-344-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAKHOURY",
"first_name": "OMAR",
"middle_name": "EASSA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-15",
"last_updated": "2023-07-12",
"certification_date": "2023-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125082900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
- Todd Christian Evans, EDS., MA, MED
- Linda Janine Evola
- Mayra Fabian
- Sadaf Fadakar, DDS
- Samad Faheem, DO
- Shawn Marten Falitz, M.D.
- Family Service & Community Mental Health Center for McHenry County
- Family Service and Community Mental Health Center for McHenry County
- Family Service and Community Mental Health Center for McHenry County
- Aaron Michael Farber, D.O.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.