NPIMap

Organization Active NPI

Midamerica Orthopaedics S.C.

Doing business as MidAmerica Hand to Shoulder Clinic

  • Orthopaedic Surgery Physician
  • Palos Hills, IL
National Provider Identifier
1710114418
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
MIDAMERICA ORTHOPAEDICS S.C.
Doing business as
MidAmerica Hand to Shoulder Clinic
Practice address
10330 S Roberts Rd
Palos Hills, IL 60465-1971
Phone
(708) 237-7200
Fax
(708) 237-7201
NPI assigned
Jun 19, 2009
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Dr. Anton J Fakhouri, M.D.NPI 1326090994
Title
President
Phone
(708) 237-7200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X
Orthopaedic Surgery Physician 207X00000X Primary
Foot & Ankle Surgery Podiatrist 213ES0103X
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

10330 S Roberts Rd
Palos Hills, IL 60465-1971

Mailing address

10330 S Roberts Rd
Palos Hills, IL 60465-1971
Phone (708) 237-7200

Other practice location 1

19065 Hickory Creek Dr Ste 210
Mokena, IL 60448-8597
Phone (708) 237-7200

Other names 1

  • MidAmerica Hand to Shoulder Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110526000367 IL Part B Supplier - Clinic/Group Practice 0547447633 Receives reassigned benefits from 28 practitioners
Practice locations: Tinley Park, IL; Palos Hills, IL; Mokena, IL; Oak Lawn, IL; Hazel Crest, IL
O20121114000164 IL DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - Family PracticeDME Supplier - Sports MedicineDME Supplier - Physician - Plastic and Reconstructive SurgeryDME Supplier - Physician - Physical and RehabilitationDME Supplier - Physician - Hand SurgeryDME Supplier - Physician - Podiatry 0547447633 Practice locations: Palos Hills, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1710114418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 S ROBERTS RD",
            "city": "PALOS HILLS",
            "state": "IL",
            "postal_code": "604651971",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 S ROBERTS RD",
            "city": "PALOS HILLS",
            "state": "IL",
            "postal_code": "604651971",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19065 Hickory Creek Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488597",
            "country_code": "US",
            "telephone_number": "708-237-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDAMERICA ORTHOPAEDICS S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-19",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "FAKHOURI",
        "authorized_official_first_name": "ANTON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-237-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MidAmerica Hand to Shoulder Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MidAmerica Hand to Shoulder Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palos Hills, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.