Active NPI
Edward Philip Mann, MD
- Ophthalmology Physician
- Chicago Ridge, IL
National Provider Identifier
1306909148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 036043622
- Practice address
- 5850 W 111TH St
Chicago Ridge, IL 60415 - Phone
- (708) 425-2466
- Fax
- (708) 425-4796
- NPI assigned
- Dec 19, 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 036043622 | IL | Primary |
Addresses
Primary practice location
5850 W 111TH St
Chicago Ridge, IL 60415
Mailing address
PO Box 379
Orland Park, IL 60462-0379
Phone (708) 460-9836
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036043622 | Medicaid | IL |
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 |
|---|---|---|---|
| 036043622 | IL | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1306909148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 379",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604620379",
"telephone_number": "708-460-9836",
"fax_number": "708-460-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5850 W 111TH ST",
"city": "CHICAGO RIDGE",
"state": "IL",
"postal_code": "60415",
"telephone_number": "708-425-2466",
"fax_number": "708-425-4796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANN",
"first_name": "EDWARD",
"middle_name": "PHILIP",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IL",
"license": "036043622",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036043622",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.