Individual provider Active NPI

Michael O'Mara, D.O.

  • Emergency Medicine Physician
  • Evergreen Park, IL
National Provider Identifier
1366426710
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036-057007 Issued in IL
Practice address
2800 W 95TH St
Evergreen Park, IL 60805-2746
Phone
(708) 422-4221
Fax
(708) 422-4415
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-057007 IL Primary

Addresses

Primary practice location

2800 W 95TH St
Evergreen Park, IL 60805-2746

Mailing address

PO Box 42898
Evergreen Park, IL 60805-0898
Phone (708) 422-4221

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050209000878 IL Practitioner - Emergency Medicine 7517852635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harvey Emergency Physicians PLLCGroup PAC ID 9436486560, 50 clinicians

Practice addresses (Care Compare)

1600 Torrence Ave
Calumet City, IL 60409-5430
Phone (954) 939-5000

Hospital & facility affiliations

  • Ingalls Memorial Hospital Hospital, Harvey, IL, CCN 140191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036-057007ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvey Emergency Physicians, PLLC Emergency Medicine CurrentSince Sep 23, 2019 Accepting new patients

Locations

1600 Torrence Ave
Calumet City, IL 60409
Phone (708) 730-1300

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

Interoperability endpoints

  • Direct secure messaging: momarado237222@uchospital.direct-ci.com

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1366426710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42898",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608050898",
            "telephone_number": "708-422-4221",
            "fax_number": "708-422-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052746",
            "telephone_number": "708-422-4221",
            "fax_number": "708-422-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'MARA",
        "first_name": "MICHAEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-057007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

Verify at the official NPI Registry.