NPIMap

Individual provider Active NPI

Ernest Walter Waintraub, M.D.

  • Emergency Medicine Physician
  • Olympia Fields, IL
National Provider Identifier
1740454552
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036126442 Issued in IL
Practice address
20201 Crawford Ave
Olympia Fields, IL 60461-1010
Phone
(708) 747-4000
NPI assigned
Apr 14, 2008
Last updated
Mar 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01068984A IN
Emergency Medicine Physician 207P00000X 55542-20 WI
Emergency Medicine Physician 207P00000X 036126442 IL Primary

Addresses

Primary practice location

20201 Crawford Ave
Olympia Fields, IL 60461-1010

Mailing address

20201 Crawford Ave
Olympia Fields, IL 60461-1010
Phone (708) 747-4000

Other practice location 1

17495 La Grange Rd
Tinley Park, IL 60487-7581
Phone (708) 226-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120514000660 IL Practitioner - Emergency Medicine 2860673449 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01068984AINMDEmergency Medicine Physician
55542-20WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Sep 1, 2021 Accepting new patients
Emerge Medstaffing LLC CurrentSince Sep 15, 2018 Accepting new patients
Osf Healthcare System CurrentSince Mar 1, 2020 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Emerge Medstaffing LLC Emergency Medicine CurrentSince Sep 15, 2018 Accepting new patients
Osf Healthcare System CurrentSince Mar 1, 2020 Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 1, 2021 Accepting new patients
Maple City Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Emergency Department Associates, P.C. Emergency Medicine Past Accepting new patients
Emergency Medicine Physicians of Will County, LLC Emergency Medicine Past Accepting new patients

Locations

30 E 15th St
Chicago Hts, IL 60411
Phone (312) 206-1064

20180 S Lagrange Rd
Frankfort, IL 60423
Phone (630) 362-1035

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1740454552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20201 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611010",
            "telephone_number": "708-747-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20201 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611010",
            "telephone_number": "708-747-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17495 La Grange Rd",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604877581",
            "country_code": "US",
            "telephone_number": "708-226-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAINTRAUB",
        "first_name": "ERNEST",
        "middle_name": "WALTER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01068984A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "55542-20",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036126442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

Verify at the official NPI Registry.