Individual provider Active NPI

Albert B Poronsky, D.O.

  • Family Medicine Physician
  • Mokena, IL
National Provider Identifier
1760405666
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036073227 Issued in IL
Practice address
21202 Owens Rd Ste 201
Mokena, IL 60448-2001
Phone
(779) 334-0020
Fax
(779) 334-0021
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036073227 IL Primary

Addresses

Primary practice location

21202 Owens Rd Ste 201
Mokena, IL 60448-2001

Mailing address

21202 Owens Rd Ste 201
Mokena, IL 60448-2001
Phone (779) 334-0020

Other practice location 1

15300 West Ave Bldg A1
Orland Park, IL 60462-4600
Phone (708) 873-2490

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
I20080115000015 IL Practitioner - Family Practice 4082621065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2 Westbrook Corporate Ctr
Suite 600
Westchester, IL 60154-5716

680 N Lake Shire Dr
Suite 1000
Chicago, IL 60611-8709

Hospital & facility affiliations

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

State licenses

LicenseStateTypeSpecialty
036073227ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Apr 12, 2023 Accepting new patients
Central Dupage Physician Group Family Medicine CurrentSince Apr 12, 2023 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

21202 Owens Rd
Ste 201
Mokena, IL 60448
Phone (779) 334-0010

15300 West Ave
Bldg A1
Orland Park, IL 60462
Phone (708) 873-2490

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

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1760405666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21202 OWENS RD STE 201",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482001",
            "telephone_number": "779-334-0020",
            "fax_number": "779-334-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21202 OWENS RD STE 201",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482001",
            "telephone_number": "779-334-0020",
            "fax_number": "779-334-0021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15300 West Ave Bldg A1",
            "address_purpose": "LOCATION",
            "city": "Orland Park",
            "state": "IL",
            "postal_code": "604624600",
            "country_code": "US",
            "telephone_number": "708-873-2490",
            "fax_number": "708-873-2495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORONSKY",
        "first_name": "ALBERT",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036073227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

Verify at the official NPI Registry.