NPIMap

Individual provider Active NPI

Mara Divis, DO

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1780824037
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036129431 Issued in IL
Practice address
5501 W Fullerton Ave
Chicago, IL 60639-1368
Phone
(733) 957-4007
Fax
(773) 395-9608
NPI assigned
Feb 26, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02003631A IN
Family Medicine Physician 207Q00000X 58.002346 OH
Family Medicine Physician 207Q00000X 036129431 IL Primary

Addresses

Primary practice location

5501 W Fullerton Ave
Chicago, IL 60639-1368

Mailing address

5501 W Fullerton Ave
Chicago, IL 60639-1368
Phone (773) 395-7400

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
I20120524000603 IL Practitioner - Family Practice 4688837800 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Physicians and Surgeons, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036129431ILMDFamily Medicine Physician
02003631AINMDFamily Medicine Physician
58.002346OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Family Medicine CurrentSince Oct 25, 2024 Accepting new patients
Cook County Current Accepting new patients
Erie Family Health Center Inc CurrentSince Sep 22, 2015 Accepting new patients
Cook County CurrentSince Oct 25, 2024 Accepting new patients
John H Stroger Jr Hospital Cook County Past Accepting new patients

Locations

5501 W Fullerton Ave
Chicago, IL 60639
Phone (733) 957-4007

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

Interoperability endpoints

  • Direct secure messaging: mdivis273421@uchospital.direct-ci.com

Organizations & group practices 6

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1780824037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391368",
            "telephone_number": "773-395-7400",
            "fax_number": "773-395-9608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391368",
            "telephone_number": "733-957-4007",
            "fax_number": "773-395-9608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVIS",
        "first_name": "MARA",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-26",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003631A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "58.002346",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036129431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.