Otero Medical Center, S.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036102552 Issued in IL

Legal business name

OTERO MEDICAL CENTER, S.C.

Practice address

4911 W Fullerton Ave
Chicago, IL 60639-2505

Phone

(773) 772-4900

Fax

(773) 772-0298

NPI assigned

Jun 17, 2009

Organization subpart

No

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

Authorized official

Name

Dr. William E Otero, MDNPI 1588776884

Title

President

Phone

(773) 772-4900

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Enrique Otero, M.D.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1588776884
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375920000000",
    "number": "1639306640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4911 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392505",
            "telephone_number": "773-772-4900",
            "fax_number": "773-772-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4911 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392505",
            "telephone_number": "773-772-4900",
            "fax_number": "773-772-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTERO MEDICAL CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-17",
        "last_updated": "2013-08-08",
        "status": "A",
        "authorized_official_last_name": "OTERO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-772-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036102552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL NUMBER",
            "identifier": "1588776884",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "01626950",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102552",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• OT-Liz PLLC
• Michiko Ota, PA-C
• Takeyoshi Ota
• Blessing E Otaigbe, FNP
• Giovanna Otavalo
• William Enrique Otero, M.D.
• David Zachary Othman, M.D., M.H.S.A
• Omar Othman, M.D.
• Othrocare Solution LLC
• Otilio Melero MDSC

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.