Otis George Allen, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

036064804 Issued in IL

Practice address

1215 Holiday Dr
Bloomington, IL 61704-2214

Phone

(309) 827-3881

Fax

(309) 661-0234

NPI assigned

Aug 3, 2005

Last updated

Aug 17, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Plastic and Reconstructive Surgery

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ogallen@directaddress.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Otis Allen MD SC

  • Plastic Surgery Physician
  • Bloomington, IL
  • NPI 1457629842
  Medicare reassignment NPD

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1306847900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 PRENZLER DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617041299",
            "telephone_number": "309-287-8049",
            "fax_number": "309-661-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 HOLIDAY DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042214",
            "telephone_number": "309-827-3881",
            "fax_number": "309-661-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "OTIS",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036064804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036064804",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ahmed Monir Ali, MBBCH (MD)
• Align Services Bloomington PLLC
• All Ways Caring Services, Inc.
• All Ways Caring Services, Inc. (All Ways Caring HomeCare)
• Paula Allee-Smith, PHD
• Alliance Eyecare, Inc.
• Alliance Healthcare Services Inc
• Allmond Eyecare, LLC
• Allyson Hawkins, PH.D. Professional Counseling Services
• Nicole Dawn Almeida, NP

• Plastic Surgery Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.