Active NPI
Samantha Haikal
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
- Peoria, IL
National Provider Identifier
1043772890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
- License
- U3866
- Practice address
- 530 NE Glen Oak Ave
Peoria, IL 61637-0001 - Phone
- (309) 655-4163
- NPI assigned
- Apr 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | 207VF0040X | U3866 | TX | Primary |
| Obstetrics & Gynecology Physician | 207V00000X | U3866 | TX |
Addresses
Primary practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
530 NE Glen Oak Box 1649
Peoria, IL 61637-0001
Phone (309) 655-4163
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240501001004 | TX | Order and Referring Only - Obstetrics/Gynecology | 6406188911 |
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- Touro Un Col of Osteopathic Medicine, Henderson, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Dallas, TX 75265
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000000000 | IL | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787011200000",
"number": "1043772890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK BOX 1649",
"city": "PEORIA",
"state": "IL",
"postal_code": "616370001",
"telephone_number": "309-655-4163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616370001",
"telephone_number": "309-655-4163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAIKAL",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-02",
"last_updated": "2026-08-18",
"certification_date": "2026-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207VF0040X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
"state": "TX",
"license": "U3866",
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "TX",
"license": "U3866",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; 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.