Individual provider Active NPI

Mariya Dmytriv-Kapeniak, M.D.

  • Adult Medicine Physician
  • Chicago, IL
National Provider Identifier
1386860997
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
036120196 Issued in IL
Practice address
1640 N Damen Ave
Chicago, IL 60647-5553
Phone
(312) 219-2230
NPI assigned
Apr 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 036120196 IL Primary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X C211159 CA

Addresses

Primary practice location

1640 N Damen Ave
Chicago, IL 60647-5553

Mailing address

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723

Other practice location 1

2540 W Chicago Ave
Chicago, IL 60622-5019
Phone (312) 470-6655

Other practice location 2

750 Redwood Hwy Frontage Rd Ste 1210
Mill Valley, CA 94941-2483
Phone (888) 663-6331

Other practice location 3

4111 Franklin St
Michigan City, IN 46360-7803
Phone (219) 873-2919

Other names 1

  • Mariya Dmytriv Professional name

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
I20090813000169 IL Practitioner - Family Practice 5395899199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
One Medical Group IncGroup PAC ID 2567623739, 330 clinicians

Practice addresses (Care Compare)

1640 N Damen Ave
Chicago, IL 60647-5553
Phone (312) 219-2230

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036120196ILMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
One Medical Group, Inc CurrentSince Nov 1, 2022 Accepting new patients
One Medical Group, Inc. CurrentSince Nov 1, 2022 Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients
Rush Oak Park Physicians Group Lake Street Past Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients

Locations

1 Embarcadero Ctr
Ste 1900
San Francisco, CA 94111

1640 N Damen Ave
Chicago, IL 60647

730 Waukegan Rd
Deerfield, IL 60015

Organizations & group practices 5

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": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1386860997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 N DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475553",
            "telephone_number": "312-219-2230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2540 W Chicago Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606225019",
            "country_code": "US",
            "telephone_number": "312-470-6655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "750 Redwood Hwy Frontage Rd Ste 1210",
            "address_purpose": "LOCATION",
            "city": "Mill Valley",
            "state": "CA",
            "postal_code": "949412483",
            "country_code": "US",
            "telephone_number": "888-663-6331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4111 Franklin St",
            "address_purpose": "LOCATION",
            "city": "Michigan City",
            "state": "IN",
            "postal_code": "463607803",
            "country_code": "US",
            "telephone_number": "219-873-2919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DMYTRIV-KAPENIAK",
        "first_name": "MARIYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "IL",
            "license": "036120196",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C211159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIYA",
            "last_name": "DMYTRIV",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.