NPIMap

Organization Active NPI

I2 Medicine LLC

Doing business as I-Squared Medical Group

  • Internal Medicine Physician
  • Oak Park, IL
National Provider Identifier
1912559303
Registry record updated Jul 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
I2 MEDICINE LLC
Doing business as
I-Squared Medical Group
Practice address
1100 Lake St Ste 125
Oak Park, IL 60301-6702
Phone
(773) 490-5611
Fax
(312) 276-8684
NPI assigned
Jul 15, 2019
Last updated
Jul 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2019

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

Authorized official

Name
Dominic D Patawaran, MDNPI 1902873342
Title
Co-Owner
Phone
(773) 490-5611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1100 Lake St Ste 125
Oak Park, IL 60301-6702

Mailing address

PO Box 25816
Chicago, IL 60625-8616
Phone (773) 490-5611

Other identifiers 1

IdentifierTypeStateIssuer
036899826OtherILLICENSE

Other names 1

  • I-Squared Medical Group Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address connect@isquaredmedicalgroup.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191001001866 IL Part B Supplier - Clinic/Group Practice 4789914920 Receives reassigned benefits from 6 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563148800000",
    "number": "1912559303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25816",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606258616",
            "telephone_number": "773-490-5611",
            "fax_number": "312-276-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LAKE ST STE 125",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603016702",
            "telephone_number": "773-490-5611",
            "fax_number": "312-276-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I2 MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-15",
        "last_updated": "2019-07-15",
        "status": "A",
        "authorized_official_last_name": "PATAWARAN",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "773-490-5611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036899826",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "connect@isquaredmedicalgroup.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1100 Lake St Ste 125",
            "city": "Oak Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "603016702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "I-Squared Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.