Provider Demographics
NPI:1871890657
Name:TRANSITIONS HOME MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:TRANSITIONS HOME MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-515-1505
Mailing Address - Street 1:8913 N PRAIRIE POINTE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1577
Mailing Address - Country:US
Mailing Address - Phone:847-515-1505
Mailing Address - Fax:847-515-1503
Practice Address - Street 1:2312 TOUHY AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-5329
Practice Address - Country:US
Practice Address - Phone:847-515-1505
Practice Address - Fax:847-515-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007375363L00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5533Medicare Oscar/Certification