Individual provider Active NPI

Yi Pang, OD

  • Optometrist
  • Chicago, IL
National Provider Identifier
1386637791
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046009799 Issued in IL
Practice address
3241 S Michigan Ave
Chicago, IL 60616-3849
Phone
(312) 225-6200
Fax
(312) 949-7660
NPI assigned
Aug 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046009799 IL Primary

Addresses

Primary practice location

3241 S Michigan Ave
Chicago, IL 60616-3849

Mailing address

3241 S Michigan Ave
Chicago, IL 60616-3849
Phone (312) 949-7287

Other identifiers 2

IdentifierTypeStateIssuer
046009799MedicaidIL
205785OtherILPTAN IL MEDICARE COOK COUNTY

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050906000600 IL Practitioner - Optometry 3971535451 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois College of OptometryGroup PAC ID 7416851639, 77 clinicians

Practice addresses (Care Compare)

3241 S Michigan Ave
Chicago, IL 60616-3878
Phone (312) 949-7751

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Suburban Eye Specialists CurrentSince Sep 24, 2019 Accepting new patients
Illinois College of Optometry Optometrist CurrentSince Feb 1, 2016 Accepting new patients

Locations

Dept 4684
Carol Stream, IL 60122
Phone (708) 952-0109

3241 S Michigan Ave
Chicago, IL 60616
Phone (312) 225-6200

10436 Southwest Hwy
Ste 1
Chicago Ridge, IL 60415
Phone (708) 423-4070

10436 Southwest Hwy
Ste 101
Chicago Ridge, IL 60415
Phone (708) 423-4192

10436 Southwest Hwy
Chicago Ridge, IL 60415
Phone (708) 423-4070

18210 La Grange Rd
Ste 210
Tinley Park, IL 60487
Phone (708) 342-7990

Interoperability endpoints

  • Direct secure messaging: yi.pang.iei@direct.ico.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1386637791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163849",
            "telephone_number": "312-949-7287",
            "fax_number": "312-999-7363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163849",
            "telephone_number": "312-225-6200",
            "fax_number": "312-949-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANG",
        "first_name": "YI",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046009799",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN IL MEDICARE COOK COUNTY",
            "identifier": "205785",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.