Individual provider Active NPI

Paul R Omastiak, MD

  • Family Medicine Physician
  • Oak Lawn, IL
National Provider Identifier
1821020124
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036070593 Issued in IL
Practice address
4301 W 95TH Street
Oak Lawn, IL 60453-2670
Phone
(708) 425-5500
Fax
(708) 425-0771
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 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 036070593 IL Primary

Addresses

Primary practice location

4301 W 95TH Street
Oak Lawn, IL 60453-2670

Mailing address

4301 W 95TH Street
Oak Lawn, IL 60453-2670
Phone (708) 425-5500

Other identifiers 1

IdentifierTypeStateIssuer
036070593MedicaidIL

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
I20100122000224 IL Practitioner - Family Practice 0042215808 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lawn Medical Center, S.C.Group PAC ID 4789689548, 11 clinicians

Practice addresses (Care Compare)

4301 W 95TH St
Oak Lawn, IL 60453-2670
Phone (708) 425-5500

Hospital & facility affiliations

  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036070593ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lawn Medical Center, S.C. Family Medicine CurrentSince Nov 8, 2006 Accepting new patients

Locations

4301 W 95th St
Oak Lawn, IL 60453
Phone (708) 425-5500

Organizations & group practices 1

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 2

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1821020124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W 95TH STREET",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532670",
            "telephone_number": "708-425-5500",
            "fax_number": "708-425-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W 95TH STREET",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532670",
            "telephone_number": "708-425-5500",
            "fax_number": "708-425-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMASTIAK",
        "first_name": "PAUL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036070593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036070593",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.