Optima Medical Center Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

OPTIMA MEDICAL CENTER INC

Practice address

4539 N Sheridan Rd
Chicago, IL 60640-5618

Phone

(773) 766-1090

NPI assigned

Apr 12, 2022

Organization subpart

No

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

Authorized official

Name

Imtiyaz Pasha

Title

Owner

Phone

(773) 766-1090

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Optima Clinical Labs Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Unknown Imtiyaz Pasha

  • Clinical Medical Laboratory
  • Chicago, IL
  • NPI 1962141895
  NPD

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1902548647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6759 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263220",
            "telephone_number": "773-766-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4539 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405618",
            "telephone_number": "773-766-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMA MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "PASHA",
        "authorized_official_first_name": "IMTIYAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-766-1090"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "525871",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optima Clinical Labs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; 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.