Individual provider Active NPI

Michelle Rae Maly, DO

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1851671622
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036141505 Issued in IL
Practice address
635 N Dearborn St Ste 100
Chicago, IL 60654-4618
Phone
(312) 694-2127
Fax
(312) 694-2129
NPI assigned
Aug 24, 2011
Last updated
Aug 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 050762 CT
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 036141505 IL Primary

Addresses

Primary practice location

635 N Dearborn St Ste 100
Chicago, IL 60654-4618

Mailing address

635 N Dearborn St Ste 100
Chicago, IL 60654-4618
Phone (312) 694-2127

Other practice location 1

4422 3rd Ave
Bronx, NY 10457-2545
Phone (718) 960-9000

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
I20160930000973 IL Practitioner - Emergency Medicine 7214191717 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

635 N Dearborn St
Chicago, IL 60654-4618
Phone (312) 926-0404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
050762CTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Cook County LLC Emergency Medicine CurrentSince Sep 26, 2016 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2023 Accepting new patients
Emerge Medstaffing LLC CurrentSince Nov 4, 2018 Accepting new patients
Emerge Medstaffing LLC Emergency Medicine Current Accepting new patients
Central Dupage Physician Group PastSince Sep 5, 2023 Accepting new patients

Locations (25 of 32)

2635 Church Rd
Ste 101
Aurora, IL 60502
Phone (630) 315-6900

820 S State Route 59
Bartlett, IL 60103
Phone (630) 213-9600

820 S State Route 59
Ste A
Bartlett, IL 60103
Phone (630) 483-5930

231 S Gary Ave
Ste 100
Bloomingdale, IL 60108
Phone (630) 893-9600

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

1135 S Delano Ct E
Ste B201
Chicago, IL 60605
Phone (312) 694-2500

1333 W Belmont Ave
Ste 100
Chicago, IL 60657
Phone (312) 693-2273

171 N Aberdeen St
Ste 100
Chicago, IL 60607
Phone (312) 694-2273

4445 W Irving Park Rd
Ste 110
Chicago, IL 60641
Phone (312) 921-0417

4732 N Lincoln Ave
Chicago, IL 60625
Phone (312) 399-0559

30 E 15th St
Chicago Hts, IL 60411
Phone (312) 206-1064

360 Station Dr
Ste 300A
Crystal Lake, IL 60014
Phone (815) 788-7500

350 S Waukegan Rd
Ste 150
Deerfield, IL 60015
Phone (312) 926-6363

1630 Sherman Ave
Ste 130
Evanston, IL 60201
Phone (224) 271-4400

20180 S Lagrange Rd
Frankfort, IL 60423
Phone (630) 362-1035

885 Roosevelt Rd
Ste 100
Glen Ellyn, IL 60137
Phone (630) 384-6200

2701 Patriot Blvd
Ste 110
Glenview, IL 60026
Phone (312) 694-2273

10350 Haligus Rd
Ste A
Huntley, IL 60142
Phone (815) 455-6100

525 Rockland Rd
Ste 100
Lake Bluff, IL 60044
Phone (847) 475-2273

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

2507 N Richmond Rd
Ste B
McHenry, IL 60051
Phone (815) 206-7500

21202 Owens Rd
Ste 101
Mokena, IL 60448
Phone (779) 334-0030

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

636 Raymond Dr
Ste 107
Naperville, IL 60563
Phone (630) 359-8396

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1314144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1851671622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 N DEARBORN ST STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606544618",
            "telephone_number": "312-694-2127",
            "fax_number": "312-694-2129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 N DEARBORN ST STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606544618",
            "telephone_number": "312-694-2127",
            "fax_number": "312-694-2129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4422 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104572545",
            "country_code": "US",
            "telephone_number": "718-960-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALY",
        "first_name": "MICHELLE",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-24",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "050762",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036141505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.