NPIMap

Organization Active NPI

Oral and Maxilloficial Head and Neck Associates LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Chicago, IL
National Provider Identifier
1821652736
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
ORAL AND MAXILLOFICIAL HEAD AND NECK ASSOCIATES LLC
Practice address
811 West Wellington Avenue
Attention: Mohammed Qaisi, MD., DMD.
Chicago, IL 60657-5123
Phone
(847) 676-0091
Fax
(847) 676-2374
NPI assigned
Apr 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

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

Authorized official

Name
Dr. Mohammed Qaisi, MD DMDNPI 1679783088
Title
Member
Phone
(318) 547-2825

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

811 West Wellington Avenue
Attention: Mohammed Qaisi, MD., DMD.
Chicago, IL 60657-5123

Mailing address

PO Box 734471
Chicago, IL 60673-4471
Phone (847) 676-0091

Other names 1

  • OMHNA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190613000700 IL Part B Supplier - Clinic/Group Practice 1951634500 Receives reassigned benefits from 8 practitioners
Practice locations: Chicago, IL; Oak Lawn, IL

National Provider Directory

National Provider Directory

Locations

913 W Wellington Ave
Fl 1
Chicago, IL 60657
Phone (773) 871-1461

4440 W 95th St
Ste 113
Oak Lawn, IL 60453
Phone (773) 296-7645

4400 W 95th St
Ste 113
Oak Lawn, IL 60453

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1821652736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734471",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606734471",
            "telephone_number": "847-676-0091",
            "fax_number": "847-676-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 WEST WELLINGTON AVENUE",
            "address_2": "ATTENTION: MOHAMMED QAISI, MD., DMD.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575123",
            "telephone_number": "847-676-0091",
            "fax_number": "847-676-2374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFICIAL HEAD AND NECK ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "QAISI",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "318-547-2825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD DMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OMHNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.