Olusegun Adekunle Ishmael, MD
Individual provider Active NPI Emergency Medicine Physician · Chicago, IL
NPI 1720142128 · NPPES record last updated Oct 13, 2020
Key facts
- NPI
- 1720142128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 036126294 (IL)
- Practice address
- 30 W Erie St
Unit 801
Chicago, IL 60654-2827 - Phone
- (312) 841-0083
- Fax
- (312) 475-0064
- NPI assigned
- Dec 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101216001076 | IL | Practitioner - Emergency Medicine | 4082678685 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01047096A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Emergency Sparta, Inc | Emergency Medicine | Current |
Accepting new patients |
| Iroquois Memorial Hospital and Resident Home | Current |
Accepting new patients | |
| Healthyworks | Current | Accepting new patients | |
| David E Ross, Jr, MD,PC | Family Medicine | Past | Accepting new patients |
| Pearl Emergency Physicians | Emergency Medicine | Past | Accepting new patients |
| Emcare Physician Providers, Inc. | Emergency Medicine | Past | Accepting new patients |
Locations
818 E Broadway St
Sparta, IL 62286
Phone (618) 443-2177
200 E Fairman Ave
Watseka, IL 60970
Phone (815) 432-5201
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01047096A | IN | |
| Emergency Medicine Physician | 207P00000X | 036126294 | IL | Yes |
Addresses
Primary practice location
30 W Erie St
Unit 801
Chicago, IL 60654-2827
Mailing address
30 W Erie St
Unit 801
Chicago, IL 60654-2827
Phone (312) 841-0083
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010407096 | Other | IN | STATE LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | olusegun.ishmael.1@15486.direct.athenahealth.com | Direct |
Other providers in Chicago, IL
- David Ishikawa
- Laura Ishikawa
- Kei Ishimaru
- Khachig K Ishkhan
- Michelle Filipski Ishler
- Jessica Ishola
- Kenechukwu Isi
- Isimi Health and Wellness PLLC
- Ainura Isina
- Cecilia Chidinma Isioma
All providers in Chicago, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.