Individual provider Active NPI

Michael Thomas Marynowski, D.O.

  • Emergency Medicine Physician
  • Oak Lawn, IL
National Provider Identifier
1396994539
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036-129670 Issued in IL
Practice address
4440 W 95TH St
Oak Lawn, IL 60453-2600
Phone
(708) 684-5354
Fax
(708) 684-1028
NPI assigned
Sep 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS015238 PA
Emergency Medicine Physician 207P00000X 036-129670 IL Primary

Addresses

Primary practice location

4440 W 95TH St
Oak Lawn, IL 60453-2600

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

320 E North Ave
Pittsburgh, PA 15212-4756
Phone (412) 359-4138

Other identifiers 1

IdentifierTypeStateIssuer
1024836330001MedicaidPA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmarynowski205078@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20120904000080 IL Practitioner - Emergency Medicine 6204028574 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pulse Vein PCGroup PAC ID 7517409147, 2 clinicians

Practice addresses (Care Compare)

1239 S Naper Blvd
Suite 115
Naperville, IL 60540-8361
Phone (630) 364-3900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-129670ILMDEmergency Medicine Physician
OS015238PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Sep 1, 2013 Accepting new patients
Pulse Vein PC Emergency Medicine CurrentSince Apr 29, 2024 Accepting new patients
Central Dupage Emergency Physicians, PC Emergency Medicine CurrentSince Mar 10, 2024 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Sep 1, 2013 Accepting new patients
Pulse Urgent Care PC CurrentSince Apr 29, 2024 Accepting new patients

Locations

595 William R Latham SR Dr
Bourbonnais, IL 60914
Phone (815) 932-8944

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866

75 Remittance Dr
Dept 1611
Chicago, IL 60675

29373 Network Pl
Chicago, IL 60673

1239 S Naper Blvd
Naperville, IL 60540

1239 S Naper Blvd
Ste 115
Naperville, IL 60540
Phone (312) 399-6725

4440 W 95th St
Oak Lawn, IL 60453
Phone (708) 346-5520

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Interoperability endpoints

  • Direct secure messaging: mmarynowski205078@direct.myadvocateaurora.org
  • Direct secure messaging: mmarynowskido322994@carlehiedirect.net

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.

Hospital & facility affiliations 2

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": "1221091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1396994539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600",
            "telephone_number": "708-684-5354",
            "fax_number": "708-684-1028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 E North Ave",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152124756",
            "country_code": "US",
            "telephone_number": "412-359-4138",
            "fax_number": "412-359-8874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARYNOWSKI",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-11",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS015238",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-129670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024836330001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmarynowski205078@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.