Madison Sample Jr., MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036093157 Issued in IL

Practice address

7435 W Talcott Ave
Chicago, IL 60631-3707

Phone

(773) 792-5162

Fax

(773) 594-8589

NPI assigned

Aug 18, 2006

Last updated

Oct 31, 2023By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL, MI2 enrollments

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 2

Specialty

Anesthesiology

Education

Washington University School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Memorial HospitalGroup PAC ID 8527976497, 210 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Healthcare Hospital, Owosso, MI, CCN 230121

Merit-based Incentive Payment System (MIPS)

Final score

82.58 of 100Reported as group

Quality

58.15

Promoting interoperability

100

Improvement activities

40

Cost

74.45

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Memorial Hospital

  dba Memorial Medical Associates

  • General Practice Physician
  • Owosso, MI
  • NPI 1235160532

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• West Central Anesthesiology Group LTD

  • Anesthesiology Physician
  • Rosemont, IL
  • NPI 1396785648
  Medicare reassignment NPD
• 360 Anesthesia PLLC

  • Anesthesiology Physician
  • Wilkes Barre, PA
  • NPI 1811637366

  IL

  Medicare reassignment NPD
• American Anesthesiology Associates of Illinois, S.C.

  • Anesthesiology Physician
  • Mokena, IL
  • NPI 1962512335
  Medicare reassignment
• Talcott Anesthesiologists, S.C.

  • Pain Medicine (Anesthesiology) Physician
  • Chicago, IL
  • NPI 1093805517
  NPD (past) Authorized official
• Memorial Hospital

  dba Memorial Medical Associates

  • Anesthesiology Physician
  • Owosso, MI
  • NPI 1659527737
  NPD
• Marine Anesthesia LLC

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1598867384
  NPD (past)
• Medical Center Anesthesia, LTD.

  • Anesthesiology Physician
  • Hoffman Estates, IL
  • NPI 1184689838
  NPD (past)

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

• Memorial Hospital

  dba Memorial Healthcare

  • General Acute Care Hospital
  • Owosso, MI
  • NPI 1063414233
  Care Compare affiliation

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1023122215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 N NORTHWEST HWY",
            "address_2": "SUITE # 302",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600683263",
            "telephone_number": "847-696-9015",
            "fax_number": "847-696-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707",
            "telephone_number": "773-792-5162",
            "fax_number": "773-594-8589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "MADISON",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01076521A",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036093157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHILD OF IL",
            "identifier": "0001620300",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INS.GROUP#",
            "identifier": "364054341",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360093157 2",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert James Samp III, LPC, CMPC, CADC
• Frederick Duane Sampang, PT, DPT
• Shivani Thakkar Sampat, OD
• Malvika H Sampath, DPT
• Jessica Samperio, MSW, LCSW, PEL
• Stefani Samples, M.D.
• Michelle Marie Sampoll
• Linda Sampram
• Christopher Hophni Sampsell, LPC
• Eugene Sampson

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.