Active NPI
Sebastian Mariategui, DO
- Surgery Physician
- Chicago, IL
National Provider Identifier
1386489946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 125.084918
- Practice address
- 1969 W Ogden Ave
Chicago, IL 60612-3765 - Phone
- (312) 864-2730
- NPI assigned
- Jun 26, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 125.084918 | IL | Primary |
Addresses
Primary practice location
1969 W Ogden Ave
Chicago, IL 60612-3765
Mailing address
1105 Pleasant St Unit 316
Oak Park, IL 60302-0004
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 |
|---|---|---|---|---|
| I20240820000642 | IL | Order and Referring Only - General Surgery | 2163960378 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.084918 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1386489946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 PLEASANT ST UNIT 316",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603020004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1969 W OGDEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123765",
"telephone_number": "312-864-2730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIATEGUI",
"first_name": "SEBASTIAN",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-26",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "125.084918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.