NPIMap

Individual provider Active NPI

Michael Sean Romberg, MD

  • Surgery Physician
  • Harvey, IL
National Provider Identifier
1043217078
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036095771 Issued in IL
Practice address
71 W 156TH St
Suite 311
Harvey, IL 60426-4260
Phone
(708) 476-8205
Fax
(815) 277-2999
NPI assigned
Jul 5, 2005
Last updated
Aug 25, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036095771 IL Primary

Addresses

Primary practice location

71 W 156TH St
Suite 311
Harvey, IL 60426-4260

Mailing address

PO Box 820
Matteson, IL 60443-0820
Phone (708) 862-7674

Other identifiers 1

IdentifierTypeStateIssuer
036095771MedicaidIL

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
I20041101000185 IL Practitioner - General Surgery 6709848948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Loyola University of Chicago, Stritch School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sas Surgical LTDGroup PAC ID 8820304322, 2 clinicians

Practice addresses (Care Compare)

1 Ingalls Dr
Harvey, IL 60426-3558
Phone (708) 333-2300

17800 Kedzie Ave
Hazel Crest, IL 60429-2029
Phone (708) 799-8000

19657 S la Grange Rd
Mokena, IL 60448-9360
Phone (708) 476-8205

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue146
Removal of skin lesions59
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sas Surgical LTD. Surgery CurrentSince Sep 9, 2015 Accepting new patients
Mso Physicians Surgery Past Accepting new patients
Daniel J Vandenberg MD SC PastSince Jan 6, 2001 Accepting new patients
South Suburban Cardiology Past Accepting new patients

Locations

71 W 156th St
Ste 311
Harvey, IL 60426
Phone (708) 339-6321

19657 S La Grange Rd
Mokena, IL 60448
Phone (708) 476-8205

19934 Wolf Rd
Unit 1039
Mokena, IL 60448

Organizations & group practices 4

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 8

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1043217078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604430820",
            "telephone_number": "708-862-7674",
            "fax_number": "708-862-1781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 W 156TH ST",
            "address_2": "SUITE 311",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604264260",
            "telephone_number": "708-476-8205",
            "fax_number": "815-277-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMBERG",
        "first_name": "MICHAEL",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036095771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095771",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvey, IL

Sources for this page

Verify at the official NPI Registry.