Samuel L Macagba Jr., MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036059682 Issued in IL

Practice address

20201 Crawford Ave
Olympia Fields, IL 60461-1010

Phone

(708) 503-3857

Fax

(708) 503-3806

NPI assigned

Jun 10, 2006

Sex

Male

Sole proprietor

No

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.

• Midstate Anesthesiologists, LTD

  • Anesthesiology Physician
  • Kankakee, IL
  • NPI 1275574998
  NPD (past) Authorized official
• Crawford Avenue Anesthesia Provider Services Urbana, LLC

  • Anesthesiology Physician
  • Urbana, IL
  • NPI 1134566615
  NPD (past)
• Madison Avenue Anesthesia Placement Services

  • Anesthesiology Physician
  • Kankakee, IL
  • NPI 1053473041
  NPD (past)
• American Anesthesiology of Illinois, LLC

  • Anesthesiology Physician
  • Merrillville, IN
  • NPI 1326224270
  NPD (past)

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1023059748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20201 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611010",
            "telephone_number": "708-503-3857",
            "fax_number": "708-503-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20201 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611010",
            "telephone_number": "708-503-3857",
            "fax_number": "708-503-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACAGBA",
        "first_name": "SAMUEL",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-10",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036059682",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036059682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Llcdental,
• Karlos Lloyd
• Flavion Lockett, CSFA
• Robert Alan Look Jr.
• Aman Luthra, MD
• Jazmine Shaynika Mack, OTR/L
• Savio G Manatt, M.D.
• Erin Mangin
• Debra D Mangrum, NP
• Abdelrahman Ahmed Mansour, DO

• Anesthesiology Physician in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; 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.