Individual provider Active NPI

Dorothy Anna Skorusa, M.D.

  • Family Medicine Physician
  • Oak Lawn, IL
National Provider Identifier
1780111435
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
125-070848 Issued in IL
Practice address
9555 S. 52ND Avenue
Oak Lawn, IL 60453-3054
Phone
(708) 422-5700
Fax
(708) 422-8225
NPI assigned
May 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X IL
Family Medicine Physician 207Q00000X 125-070848 IL Primary

Addresses

Primary practice location

9555 S. 52ND Avenue
Oak Lawn, IL 60453-3054

Mailing address

9555 S. 52ND Avenue
Oak Lawn, IL 60453-3054
Phone (708) 422-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125-070848ILMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1780111435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 S. 52ND AVENUE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604533054",
            "telephone_number": "708-422-5700",
            "fax_number": "708-422-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 S. 52ND AVENUE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604533054",
            "telephone_number": "708-422-5700",
            "fax_number": "708-422-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKORUSA",
        "first_name": "DOROTHY",
        "middle_name": "ANNA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-12",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125-070848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.