Individual provider Active NPI

Michael D Dastice, MD

  • Gastroenterology Physician
  • Oak Lawn, IL
National Provider Identifier
1952358939
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036086042 Issued in IL
Practice address
10500 S Cicero Ave
Oak Lawn, IL 60453-5205
Phone
(708) 424-1202
Fax
(708) 424-1395
NPI assigned
May 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036086042 IL Primary

Addresses

Primary practice location

10500 S Cicero Ave
Oak Lawn, IL 60453-5205

Mailing address

29373 Network PL
Chicago, IL 60673-1293

Other practice location 1

4400 W 95th St Ste 310
Oak Lawn, IL 60453-2660
Phone (708) 684-9230

Other identifiers 1

IdentifierTypeStateIssuer
036086042MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mdastice279348@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111129000111 IL Practitioner - Gastroenterology 0547434755 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Loyola University of Chicago, Stritch School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10500 S Cicero Ave
Oak Lawn, IL 60453-5205
Phone (708) 424-1202

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

4400 W 95TH St
Suite 306
Oak Lawn, IL 60453-2659
Phone (708) 684-5428

4440 W 95TH St
Oak Lawn, IL 60453-2600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy129
Upper gastrointestinal (GI) endoscopy for acid reflux142

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036086042ILMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2024 Accepting new patients
Elgin Gastroenterology SC Gastroenterology Current Accepting new patients
Illinois Gastroenterology Group, LLC Gastroenterology CurrentSince Jan 1, 2021 Accepting new patients
Northwest Gastroenterologists SC Current Accepting new patients
Gi Partners of Illinois, PLLC Gastroenterology CurrentSince Jan 1, 2017 Accepting new patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2024 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

9831 S Western Ave
Chicago, IL 60643
Phone (773) 445-3500

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

1880 W Winchester Rd
Ste 201
Libertyville, IL 60048
Phone (847) 247-0187

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

4400 W 95th St
Ste 310
Oak Lawn, IL 60453
Phone (708) 684-9230

10500 S Cicero Ave
Oak Lawn, IL 60453
Phone (708) 424-1202

Interoperability endpoints

  • Direct secure messaging: mdastice279348@direct.myadvocateaurora.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1952358939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10500 S CICERO AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604535205",
            "telephone_number": "708-424-1202",
            "fax_number": "708-424-1395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4400 W 95th St Ste 310",
            "address_purpose": "LOCATION",
            "city": "Oak Lawn",
            "state": "IL",
            "postal_code": "604532660",
            "country_code": "US",
            "telephone_number": "708-684-9230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DASTICE",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036086042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086042",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdastice279348@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4400 W 95th St Ste 310",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4400 W 95th St Ste 310",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.