DR. TIA J DORN (M.D.) – Family Medicine Physician, NPI 1285074740
Family Medicine Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. TIA J DORN (M.D.)
1 Erie Ct
Suite 6160
Oak Park, IL 603022566
Phone: (708) 763-1490
Fax: (708) 763-7232
Type: Location
1 ERIE CT
SUITE 6160
OAK PARK, IL 603022566
Phone: (708) 763-1490
Fax: (708) 763-7232
Type: Mailing
3777 N FRONTAGE RD
MICHIGAN CITY, IN 463607695
Phone: (219) 877-3841
Type: Location
823 GATEWAY CENTER WAY
SAN DIEGO, CA 921024541
Phone: (619) 515-2300
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $68.
Total Amount is formed as General ($68) + Research ($0) + Ownership ($0) = $68.
Last reported payment date: 2023-11-15 • Largest payer in this snapshot: Axonics, Inc. ($68).
Total Amount
$68
General + Research + Ownership
Payments
1
Total payment records
General Amount
$68
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Axonics, Inc. | $68 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-12-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20211229002176 | I | Family Practice | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60302)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiovascular Disease (Cardiology) | WI | |
| Nurse Practitioner | IN | |
| O P H T H A L M O L O G Y | IN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | IN | |
| Interventional Cardiology | TX | |
| Nurse Practitioner | IN | |
| - | IN | |
| - | IN | |
| - | IN | |
| Physician Assistant | CT |
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