NPIMap

Individual provider Active NPI

John G Scaramella, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1033159157
Registry record updated Jun 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036087838 Issued in IL
Practice address
4920 N Central Ave
Suite 2B
Chicago, IL 60630-2338
Phone
(773) 202-5959
Fax
(773) 202-9144
NPI assigned
Jun 7, 2006
Last updated
Jun 3, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036087838 IL Primary

Addresses

Primary practice location

4920 N Central Ave
Suite 2B
Chicago, IL 60630-2338

Mailing address

PO Box 7389
Prospect Heights, IL 60070-7389
Phone (847) 870-3600

Other identifiers 1

IdentifierTypeStateIssuer
036087838MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080813000684 IL Practitioner - Family Practice 5991870727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
R Franklin University of Med & Sci/Chicago Medical School, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4920 N Central Ave
Suite 2B
Chicago, IL 60630-2346
Phone (771) 202-5959

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036087838ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John G Scaramella MD SC Single Specialty CurrentSince Aug 13, 2008 Accepting new patients
Andrzej P. Indyk, M.D.S.C. Single Specialty Current Accepting new patients

Locations

4920 N Central Ave
Ste 2B
Chicago, IL 60630
Phone (771) 202-5959

Organizations & group practices 2

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.

Hospital & facility affiliations 10

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401753600000",
    "number": "1033159157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7389",
            "city": "PROSPECT HEIGHTS",
            "state": "IL",
            "postal_code": "600707389",
            "telephone_number": "847-870-3600",
            "fax_number": "847-870-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 N CENTRAL AVE",
            "address_2": "SUITE 2B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302338",
            "telephone_number": "773-202-5959",
            "fax_number": "773-202-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCARAMELLA",
        "first_name": "JOHN",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036087838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036087838",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.