Individual ProviderLuciano OrtaEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4201 W Medical Center Dr, Mchenry, IL 60050-8409(815) 759-3100PECOS EnrollmentBased on the most recent information from CMS, provider Luciano Orta is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1346353505Provider TypeIndividualFull NameOrta, LucianoTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date8/15/2006Last Updated5/3/2021Contact InformationPractice LocationPractice Address4201 W Medical Center Dr, Mchenry, IL 60050-8409Phone(815) 759-3100Fax(815) 363-9094Mailing LocationMailing Address4201 W Medical Center Dr, Mchenry, IL 60050-8409Phone(815) 759-3100Fax(815) 363-9094Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense036084476IllinoisCode207P00000XDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense47498-20WisconsinProvider IdentifiersIDDescriptionIssuerID1346353505DescriptionMedicaidIssuerUnlistedWisconsinIDORTALUCDescriptionOtherIssuerMERCYCARE INSURANCEWisconsinID036084476 2DescriptionMedicaidIssuerUnlistedIllinois