NPIMap

Individual provider Active NPI

Dominic Patawaran, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1902873342
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36099826 Issued in IL
Practice address
500 N Michigan Ave Ste 2100
Chicago, IL 60611-3773
Phone
(312) 276-1212
Fax
(312) 276-1213
NPI assigned
Mar 3, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36099826 IL Primary

Addresses

Primary practice location

500 N Michigan Ave Ste 2100
Chicago, IL 60611-3773

Mailing address

500 N Michigan Ave Ste 2100
Chicago, IL 60611-3773
Phone (312) 276-1212

Other identifiers 1

IdentifierTypeStateIssuer
1902873342OtherILNPI

Other names 1

  • Dr. Dominic Patawaran Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130122000509 IL Practitioner - Family Practice 4587612635 Reassigns benefits to 2 organizations
Practice locations: Oak Park, IL

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
I2 Medicine LLCGroup PAC ID 4789914920, 5 clinicians

Practice addresses (Care Compare)

939 W N Ave
Suite 650
Chicago, IL 60642-8684
Phone (773) 377-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36099826ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Specialty Integrative Nutrition, LLC CurrentSince Mar 1, 2020 Accepting new patients
Swedish Covenant Management Services, Inc. CurrentSince Feb 1, 2019 Accepting new patients
Swedish Covenant Management Services, Inc. Family Medicine Current Accepting new patients
I2 Medicine LLC Family Medicine CurrentSince Sep 5, 2019 Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Feb 1, 2019 Accepting new patients
Doctor Bogard Chang Optometry Inc Past Accepting new patients
Oak Park Medical Services PC Family Medicine PastSince Feb 1, 2016 Accepting new patients
Dwight H. Smith, M.D., Inc Past Accepting new patients

Locations

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

939 W North Ave
Ste 650
Chicago, IL 60642
Phone (773) 377-8000

1100 Lake St
Ste 125
Oak Park, IL 60301
Phone (708) 386-3080

Organizations & group practices 8

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 5

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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1902873342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N MICHIGAN AVE STE 2100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113773",
            "telephone_number": "312-276-1212",
            "fax_number": "312-276-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N MICHIGAN AVE STE 2100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113773",
            "telephone_number": "312-276-1212",
            "fax_number": "312-276-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATAWARAN",
        "first_name": "DOMINIC",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36099826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1902873342",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOMINIC",
            "last_name": "PATAWARAN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.