CMS-1500 Box 24J / 33a • NPI
1174255053
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
207WX0110X (CMS 18)
Board-Certified in Ophthalmology (Medical & Microsurgical Eye Doctor)
Box 32 Service Location & ZIP+4
4927 N GLEN PARK PLACE RD, PEORIA, IL, 61614-4676
✓ 9-Digit EDI 837 ZIP+4 (61614-4676)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174255053 (OSAMA AL DEYABAT, MBBS) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
✓ Eligible
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1174255053)
Medicare Beneficiaries
19
Total Billed Services
21
Distinct CPT/HCPCS Codes
3
Medicare Allowed Total
$399.40
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1174255053 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | OSAMA AL DEYABAT, MBBS |
| Plain-English Specialty | Board-Certified in Ophthalmology (Medical & Microsurgical Eye Doctor) NUCC Code: 207WX0110X (Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist) |
| Certifying / Licensing Body | American Board of Ophthalmology (ABO) |
| Practice Location Address | 4927 N GLEN PARK PLACE RD, PEORIA, IL, 61614-4676 |
| Practice Telephone / Fax | Tel: (309) 308-3500 |
| Administrative Mailing Address | 1601 W CONEFLOWER DR APT 4302, PEORIA, IL, 61615-7438 |
| Enumeration & Last Sync | Enumerated: 2022-06-29 | CMS Record Updated: 2024-09-23 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (207WX0110X)
What Does Taxonomy Code 207WX0110X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207WX0110X translates to:
"Board-Certified in Ophthalmology (Medical & Microsurgical Eye Doctor)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (OSAMA AL DEYABAT, MBBS)
Typical CPT / Diagnostic Procedures:- Phacoemulsification Cataract Extraction with Intraocular Lens (IOL) Implantation (CPT 66984)
- Optical Coherence Tomography (OCT) of Retina & Optic Nerve (CPT 92134)
- Intravitreal Anti-VEGF Injections for Macular Degeneration & Diabetic Retinopathy
- Comprehensive Slit-Lamp Biomicroscopy & Tonometry Glaucoma Screening
- Prostaglandin Analog Eye Drops (Latanoprost, Bimatoprost) & Timolol (Glaucoma)
- Moxifloxacin & Ciprofloxacin Ophthalmic Solutions
- Prednisolone Acetate & Ketorolac Post-Cataract Ophthalmic Drops
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207W00000X — OphthalmologyPlain English: Board-Certified in Ophthalmology (Medical & Microsurgical Eye Doctor) | State: IL | License: 036171176 | Primary: Secondary |
207WX0109X — Ophthalmology, Neuro-ophthalmologyPlain English: Board-Certified in Ophthalmology (Medical & Microsurgical Eye Doctor) | State: IL | License: 036171176 | Primary: Secondary |
207WX0110X — Ophthalmology, Pediatric Ophthalmology and Strabismus SpecialistPlain English: Board-Certified in Ophthalmology (Medical & Microsurgical Eye Doctor) | State: IL | License: 036171176 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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