Individual provider Active NPI

Victor Manuel Medina, D.O.

  • Hematology & Oncology Physician
  • McHenry, IL
National Provider Identifier
1720492572
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
036152203 Issued in IL
Practice address
4305 W Medical Center Dr Ste 1
McHenry, IL 60050-8425
Phone
(815) 759-8100
Fax
(815) 759-8106
NPI assigned
Jun 19, 2014
Last updated
Mar 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 036152203 IL Primary

Addresses

Primary practice location

4305 W Medical Center Dr Ste 1
McHenry, IL 60050-8425

Mailing address

10370 Haligus Rd Ste 202
Huntley, IL 60142-9582
Phone (847) 802-7480

Other practice location 1

10370 Haligus Rd Ste 202
Huntley, IL 60142-9582
Phone (847) 802-7480

Other practice location 2

1475 E Belvidere Rd
Grayslake, IL 60030-2012
Phone (847) 582-2134

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200707001158 IL Practitioner - Hematology/OncologyPractitioner - Internal Medicine 3072834753 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1475 E Belvidere Rd
Gryslk Op and Acute
Grayslake, IL 60030-2012
Phone (847) 535-8894

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Internal Medicine CurrentSince Jul 20, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 1, 2021 Accepting new patients
Central Dupage Physician Group CurrentSince Jul 20, 2020 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

304 Randall Rd
Geneva, IL 60134
Phone (630) 232-0610

1475 E Belvidere Rd
Grayslake, IL 60030
Phone (847) 535-8800

10370 Haligus Rd
Ste 202
Huntley, IL 60142
Phone (847) 802-7280

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4305 W Medical Center Dr
Ste 1
McHenry, IL 60050
Phone (815) 759-8100

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1720492572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10370 HALIGUS RD STE 202",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429582",
            "telephone_number": "847-802-7480",
            "fax_number": "847-802-7485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 W MEDICAL CENTER DR STE 1",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508425",
            "telephone_number": "815-759-8100",
            "fax_number": "815-759-8106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10370 Haligus Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429582",
            "country_code": "US",
            "telephone_number": "847-802-7480",
            "fax_number": "847-802-7485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1475 E Belvidere Rd",
            "address_purpose": "LOCATION",
            "city": "Grayslake",
            "state": "IL",
            "postal_code": "600302012",
            "country_code": "US",
            "telephone_number": "847-582-2134",
            "fax_number": "847-535-7285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "VICTOR",
        "middle_name": "MANUEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-19",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IL",
            "license": "036152203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.