Oak Park Kidney Center LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

142644 Issued in IL

Legal business name

OAK PARK KIDNEY CENTER LLC

Practice address

610 S Maple Ave
Ste 4100
Oak Park, IL 60304-1091

Phone

(708) 660-4100

Fax

(708) 660-4103

NPI assigned

Aug 13, 2006

Organization subpart

No

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

Authorized official

Name

Kareem M Syed Shah, RN, MSN

Title

Unit Director

Phone

(708) 660-4100

Specialties & licenses 1

Addresses

Other names 1

• Maple Avenue Kidney Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Maple Avenue Kidney CenterCCN 142644

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Dec 12, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

18

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Humayun S S C

  • Nephrology Physician
  • Chicago, IL
  • NPI 1710074976

  Member Of

  NPD member

Practitioners 1

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

• Hamid M Humayun, MD

  • Nephrology Physician
  • Chicago, IL
  • NPI 1275550964
  NPD

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Hamid M Humayun, MD

  • Nephrology Physician
  • Chicago, IL
  • NPI 1275550964

  Dialysis facility

  Care Compare affiliation Name & address match
• Wasay Humayun, M.D.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1013154327

  Dialysis facility

  Care Compare affiliation Name & address match
• Vaseem Qureshi, M.D.

  • Nephrology Physician
  • Chicago, IL
  • NPI 1003838574

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1891707196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 S MAPLE AVE",
            "address_2": "STE 4100",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041091",
            "telephone_number": "708-660-4100",
            "fax_number": "708-660-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 S MAPLE AVE",
            "address_2": "STE 4100",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041091",
            "telephone_number": "708-660-4100",
            "fax_number": "708-660-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK PARK KIDNEY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "SYED SHAH",
        "authorized_official_first_name": "KAREEM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "UNIT DIRECTOR",
        "authorized_official_telephone_number": "708-660-4100",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "IL",
            "license": "142644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Avenue Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Avenue Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oak Park, IL
• Providers in Oak Park, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.