Active NPI
Omar Ahmed Rafa, DO
- Student in an Organized Health Care Education/Training Program
- Kankakee, IL
National Provider Identifier
1407596752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 125.086172
- Practice address
- 500 N Wall St Ste C100
Kankakee, IL 60901-2942 - Phone
- (844) 404-4787
- NPI assigned
- Apr 1, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 125.086172 | IL | Primary |
Addresses
Primary practice location
500 N Wall St Ste C100
Kankakee, IL 60901-2942
Mailing address
500 N Wall St Ste C100
Kankakee, IL 60901-2942
Phone (844) 404-4787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.086172 | IL | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773014400000",
"number": "1407596752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 N WALL ST STE C100",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012942",
"telephone_number": "844-404-4787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N WALL ST STE C100",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012942",
"telephone_number": "844-404-4787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAFA",
"first_name": "OMAR",
"middle_name": "AHMED",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-01",
"last_updated": "2026-03-09",
"certification_date": "2026-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": "125.086172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.