James A Ida Jr., MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036.132972 Issued in IL

Practice address

1663 W Carmen Ave
Chicago, IL 60640-2701

Phone

(773) 293-7500

NPI assigned

Oct 10, 2007

Last updated

Apr 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Northside Dermatology, S.C.

  • Medical Specialty Clinic/Center
  • Chicago, IL
  • NPI 1861943888
  Authorized official Same address or phone
• Adams Street Dermatology Assoc, PC

  • Dermatology Physician
  • Quincy, MA
  • NPI 1164693289

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1013105444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 W CARMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402701",
            "telephone_number": "773-293-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 W CARMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402701",
            "telephone_number": "773-293-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDA",
        "first_name": "JAMES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-10",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "242826",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.132972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Icz Medical Group (Pain management center)
• Id
• Id Chicago Inc
• Ida Lillie Psychotherapy and Wellness
• Ida Mae Dental Clinic
• Jonathan Benjamin Ida, M.D.
• Josue Gedeon Otniel Idani
• Juan David Idarraga Parra, M.D.
• Sabrina Patricia Iddir, MD
• Ideal Family Eye Care LTD

• Dermatology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.