NPIMap

Individual provider Active NPI

Raymond P Dipasquo, D.O.

  • Family Medicine Physician
  • Homer Glen, IL
National Provider Identifier
1912950916
Registry record updated May 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036069676 Issued in IL
Practice address
12701 W 143Rd St
Suite 250
Homer Glen, IL 60491-7715
Phone
(708) 301-1400
Fax
(708) 301-4295
NPI assigned
May 19, 2006
Last updated
May 18, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2012

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 036069676 IL Primary

Addresses

Primary practice location

12701 W 143Rd St
Suite 250
Homer Glen, IL 60491-7715

Mailing address

12701 W 143Rd St
Suite 250
Homer Glen, IL 60491-7715
Phone (708) 301-1400

Other identifiers 1

IdentifierTypeStateIssuer
036069676MedicaidIL

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
I20100327000593 IL Practitioner - Family Practice 1355477431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Health Associates PCGroup PAC ID 0749254845, 9 clinicians

Practice addresses (Care Compare)

10300 Village Circle Dr
Palos Park, IL 60464-3541
Phone (708) 361-6091

12701 W 143Rd St
Suite 250
Homer Glen, IL 60491-7727
Phone (708) 301-1400

16512 S 106TH CT
Orlando Park, IL 60467-4547
Phone (708) 364-8323

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Health Associates PC Family Medicine CurrentSince Jan 1, 1998 Accepting new patients

Locations

12701 W 143rd St
Ste 250
Homer Glen, IL 60491
Phone (708) 301-1400

15300 West Ave
Ste 122
Orland Park, IL 60462
Phone (708) 226-2400

16512 106th Ct
Orland Park, IL 60467
Phone (708) 364-8323

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JGEBDA
  • Direct secure messaging: raymond.dipasquo@pha16512.eclinicaldirectplus.com

Organizations & group practices 1

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 10

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337299200000",
    "number": "1912950916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "address_2": "SUITE 250",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "708-301-1400",
            "fax_number": "708-301-4295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "address_2": "SUITE 250",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "708-301-1400",
            "fax_number": "708-301-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIPASQUO",
        "first_name": "RAYMOND",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2012-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036069676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036069676",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer Glen, IL

Sources for this page

Verify at the official NPI Registry.