Individual provider Active NPI

Susan Sam

  • Endocrinology, Diabetes & Metabolism Physician
  • Chicago, IL
National Provider Identifier
1013020759
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
036097450 Issued in IL
Practice address
5841 S Maryland Ave
Chicago, IL 60637-1443
Phone
(888) 824-0200
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 036097450 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave
Chicago, IL 60637-1443

Mailing address

150 Harvester Dr
Suite 300
Burr Ridge, IL 60527-5919

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssammd76456@uchospital.direct-ci.com University of Chicago Physicians Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061213000401 IL Practitioner - Endocrinology 8628077955 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians
The University of Chicago Medical CenterGroup PAC ID 7618880766, 907 clinicians

Practice addresses (Care Compare)

355 E Grand Ave
Chicago, IL 60611-5389
Phone (888) 824-0200

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (773) 702-1000

Hospital & facility affiliations

  • The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036097450ILMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation Current Accepting new patients
The University of Chicago Medical Center CurrentSince Oct 31, 2013 Accepting new patients
The University of Chicago Medical Center CurrentSince Oct 31, 2013 Accepting new patients
University of Chicago CurrentSince Sep 1, 2013 Accepting new patients
Board of Trustees of the University of Illinois PastSince Jan 24, 2021 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

Dept 5777
Carol Stream, IL 60122

1740 W Taylor St
#3462
Chicago, IL 60612
Phone (312) 704-2885

355 E Grand Ave
Chicago, IL 60611
Phone (312) 587-3432

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: ssammd76456@uchospital.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1013020759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR",
            "address_2": "SUITE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "888-824-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAM",
        "first_name": "SUSAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": "036097450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssammd76456@uchospital.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "University of Chicago Physicians Group",
            "address_1": "5841 S Maryland Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606371443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.