Individual provider Active NPI

Mary F Roberts, OD

  • Optometrist
  • Chicago, IL
National Provider Identifier
1790778108
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046008468 Issued in IL
Practice address
3241 S Michigan Ave
Chicago, IL 60616-3849
Phone
(312) 225-6200
Fax
(319) 949-7600
NPI assigned
Aug 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046008468 IL Primary

Addresses

Primary practice location

3241 S Michigan Ave
Chicago, IL 60616-3849

Mailing address

3241 S Michigan Ave
Chicago, IL 60616-3849
Phone (312) 949-7309

Other identifiers 1

IdentifierTypeStateIssuer
046008468MedicaidIL

Other names 1

  • Mary F Flynn Other name

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100330000930 IL Practitioner - Optometry 3173659059 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois College of OptometryGroup PAC ID 7416851639, 77 clinicians
Melrose Park Eye Care LLCGroup PAC ID 6709315518, 7 clinicians

Practice addresses (Care Compare)

3241 S Michigan Ave
Chicago, IL 60616-3878
Phone (312) 949-7751

904 W N Ave
Melrose Park, IL 60160-1520
Phone (708) 343-9009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046008468ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois College of Optometry Optometrist CurrentSince Jan 1, 1987 Accepting new patients
Melrose Park Eye Care LLC Optometrist CurrentSince Jan 29, 2025 Accepting new patients
Wilma, LTD Optometrist CurrentSince Nov 13, 2023 Accepting new patients

Locations

3241 S Michigan Ave
Chicago, IL 60616
Phone (312) 225-6200

904 W North Ave
Melrose Park, IL 60160
Phone (708) 343-6767

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: mary.flynn.roberts.iei@direct.ico.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1790778108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163849",
            "telephone_number": "312-949-7309",
            "fax_number": "312-949-7653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163849",
            "telephone_number": "312-225-6200",
            "fax_number": "319-949-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARY",
        "middle_name": "F",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008468",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "FLYNN",
            "middle_name": "F",
            "credential": "OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.