Individual provider Active NPI

Mariani Del Valle Salazar Leon, MD

  • Internal Medicine Physician
  • Oak Lawn, IL
National Provider Identifier
1871080663
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036155677 Issued in IL
Practice address
4440 W 95TH St
Oak Lawn, IL 60453-2600
Phone
(773) 677-8380
NPI assigned
Apr 17, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 036155677 IL Primary

Addresses

Primary practice location

4440 W 95TH St
Oak Lawn, IL 60453-2600

Mailing address

1111 Thomas St
Oak Park, IL 60302-1534
Phone (224) 256-0159

Other practice location 1

836 W Wellington Ave
Chicago, IL 60657-5147
Phone (773) 975-1600

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address msalazarleon208538@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20210614000909 IL Practitioner - Internal Medicine 3476806183 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

4440 W 95TH St
Oak Lawn, IL 60453-2600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036155677ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jul 9, 2021 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jul 9, 2021 Accepting new patients
Chicago Gastro LLC Past Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

836 W Wellington Ave
Chicago, IL 60657
Phone (773) 296-7054

29373 Network Pl
Chicago, IL 60673

4440 W 95th St
Oak Lawn, IL 60453
Phone (708) 346-5520

Organizations & group practices 4

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 3

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": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1871080663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 THOMAS ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021534",
            "telephone_number": "224-256-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600",
            "telephone_number": "773-677-8380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "836 W Wellington Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606575147",
            "country_code": "US",
            "telephone_number": "773-975-1600",
            "fax_number": "773-296-5265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SALAZAR LEON",
        "first_name": "MARIANI",
        "middle_name": "DEL VALLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-17",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036155677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msalazarleon208538@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.