DORIS FANDOHAN NURSE PRACTITIONER
NPI 1679038186
Nurse Practitioner - Family in Blue Island, IL

Q: What is Doris Fandohan's NPI number?

The NPI number for Doris Fandohan is 1679038186. It was assigned to this individual provider in the NPPES registry on February 8, 2019.

Q: What is Doris Fandohan's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Doris Fandohan was last updated on June 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 08, 2019PECOS EnrolledAccepts Medicare Assignment

3046 127TH ST, BLUE ISLAND, IL 60406(708) 377-7920(708) 930-0414 Get Directions Write a Review

NPPES record last updated: June 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 6, 2025, Mar 28, 2025, Apr 20, 2020 and 1 more (4 updates tracked since 2019).

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About Doris Fandohan Nurse Practitioner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DORIS FANDOHAN NURSE PRACTITIONER (NPI 1679038186) is an individual family provider in Blue Island, Illinois, licensed in Illinois (209019405) and active in the NPI registry since February 2019. She is enrolled in Medicare PECOS, is affiliated with Osf Little Company Of Mary Medical Center, and maintains a secondary practice location in Gary.

NPPES Registry Identity

NPI1679038186

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameDORIS FANDOHANCredential: NURSE PRACTITIONER

Location Address3046 127TH STBlue Island, IL 60406-1827

Mailing AddressPo Box 746715Atlanta, GA 30374-6715 · (773) 352-1515 · Fax (312) 929-0373

Phone(708) 377-7920

Fax(708) 930-0414

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateFebruary 8, 2019

Last NPPES UpdateJune 6, 20254 updates tracked since enumeration

NPPES CertifiedJune 6, 2025

✔ NPI 1679038186 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in IL · 209019405✔ Licensed in IN · 71008752A

3046 127TH ST, Blue Island, IL 60406

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Secondary Practice Location 1

Location 13535 BroadwayGary, IN 46409-1316 · Phone (219) 884-4900 · Fax (219) 980-7585

Other Identifiers 1

Other71008752AIN · Nurse Practitioner License Number

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Doris Fandohan Nurse Practitioner is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1557603974

PECOS Enrollment IDI20200501000028

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

128 services68 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

24 services24 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Osf Little Company Of Mary Medical Center

Acute Care Hospitals · Evergreen Park, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140179

Location2800 W 95th StEvergreen Park, IL 60805 · Cook County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60406 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KEVIN PAUL MALONE D.P.M.

Podiatrist