Phillip Michael O'Connor, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

036152000 Issued in IL

Practice address

1240 Westlawn Dr
Kankakee, IL 60901-4657

Phone

(815) 693-7568

NPI assigned

May 11, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

General PracticeAlso: Physical Medicine and Rehabilitation

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wound Kinetics L L CGroup PAC ID 6800334905, 2 clinicians

Vivek Gupta, M.D., S.C.Group PAC ID 3678668308, 28 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Vivek Gupta, M.D., S.C.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1033300694
  Medicare reassignment Care Compare group NPD
• Wound Kinetics L L C

  • Physical Medicine & Rehabilitation Physician
  • Kankakee, IL
  • NPI 1013755909
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1659759652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 WESTLAWN DR",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609014657",
            "telephone_number": "815-693-7568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 WESTLAWN DR",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609014657",
            "telephone_number": "815-693-7568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Township Line Rd",
            "address_purpose": "LOCATION",
            "city": "Elkins Park",
            "state": "PA",
            "postal_code": "190272220",
            "country_code": "US",
            "telephone_number": "215-663-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "82-68 164th Street",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "11432",
            "country_code": "US",
            "telephone_number": "718-883-4080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 N Broad St Lowr Level",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-7020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "PHILLIP",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-11",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "MT212023",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036152000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Scot Nicklas, DDS
• Judith Njoroge, DO
• Novus Illinois Service Corporation
• Danielle D Nunley, PHARMD
• Nushape Illinois Inc.
• Oakside Corporation
• Oakside Corporation
• Michael C Olimene, PHARM D
• Brian Patrick Olofsson, MD
• Cheryl Ann Olofsson, RN

• General Practice Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.