Active NPI
Omnicare Labs of Champaign Inc
- Prosthetic/Orthotic Supplier
- Mattoon, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- 211000198
- Legal business name
- OMNICARE LABS OF CHAMPAIGN INC
- Practice address
- 201 Richmond Ave E
Ste 5
Mattoon, IL 61938-4665 - Phone
- (217) 235-6664
- Fax
- (217) 235-6655
- NPI assigned
- Apr 2, 2014
- Organization subpart
- Yes
- Parent organization
- OMNICARE LABS OF CHAMPAIGN
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. William R Devlin, CPO/L
- Title
- President Cpo/L
- Phone
- (217) 344-6664
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | 211000198 | IL | Primary |
| Prosthetic/Orthotic Supplier | 335E00000X | 213000216 | IL |
Addresses
Primary practice location
201 Richmond Ave E
Ste 5
Mattoon, IL 61938-4665
Mailing address
502 S Vine St
Urbana, IL 61801-4220
Phone (217) 344-6664
Other names 1
- OMNI PROSTHETICS AND ORTHOTICS
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140502000175 | IL | DME Supplier - Orthotic Personnel | 2860607520 | Practice locations: Mattoon, IL |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Omnicare Labs of Champaign Inc | Contracture Treatment Devices: Dynamic Splint|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Omnicare Labs of Champaign Inc
- Part of
- Omnicare Labs of Champaign Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Prosthetic/Orthotic Supplier
- Urbana, IL
- NPI 1720142094
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
201 Richmond Ave E
Ste 5
Mattoon, IL 61938
Phone (217) 235-6664
502 S Vine St
Urbana, IL 61801
Phone (217) 344-6664
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Prosthetic/Orthotic Supplier
- Urbana, IL
- NPI 1720142094
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396396800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747958400000",
"number": "1972921302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 S VINE ST",
"city": "URBANA",
"state": "IL",
"postal_code": "618014220",
"telephone_number": "217-344-6664",
"fax_number": "217-344-9282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 RICHMOND AVE E",
"address_2": "STE 5",
"city": "MATTOON",
"state": "IL",
"postal_code": "619384665",
"telephone_number": "217-235-6664",
"fax_number": "217-235-6655"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OMNICARE LABS OF CHAMPAIGN INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OMNICARE LABS OF CHAMPAIGN",
"enumeration_date": "2014-04-02",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A",
"authorized_official_last_name": "DEVLIN",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "PRESIDENT CPO/L",
"authorized_official_telephone_number": "217-344-6664",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CPO/L"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "IL",
"license": "211000198",
"primary": true
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "IL",
"license": "213000216",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "OMNI PROSTHETICS AND ORTHOTICS",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mattoon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; 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.