NPIMap

Individual provider Active NPI

Abdallah Mahmoud Hamdallah

  • Clinical Neurophysiology Physician
  • Palos Heights, IL
National Provider Identifier
1053726760
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
036.145234 Issued in IL
Practice address
11824 Southwest Hwy Ste 100
Palos Heights, IL 60463-1083
Phone
(708) 361-0222
Fax
(708) 361-6450
NPI assigned
Jun 23, 2014
Last updated
Jun 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301104995 MI
Clinical Neurophysiology Physician 2084N0600X 036.145234 IL Primary

Addresses

Primary practice location

11824 Southwest Hwy Ste 100
Palos Heights, IL 60463-1083

Mailing address

29373 Network PL
Chicago, IL 60673-1443
Phone (847) 390-5900

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address ahamdallah229733@direct.myadvocateaurora.org Direct

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
I20190710001149 IL Practitioner - Neurology 1052537818 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1775 Dempster St
Park Ridge, IL 60068-1143

17800 Kedzie Ave
Hazel Crest, IL 60429-2029
Phone (708) 684-5340

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

2320 E 93Rd St
Chicago, IL 60617-3909
Phone (773) 967-3999

4440 W 95TH St
Oak Lawn, IL 60453-2600

836 W Wellington
Suite G346
Chicago, IL 60657-5147
Phone (773) 296-7147

836 W Wellington Ave
Chicago, IL 60657-5147

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301104995MIMDNeurology Physician
036.145234ILMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Nov 11, 2022 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Mar 1, 2023 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Mar 1, 2023 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jun 22, 2019 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince Jun 22, 2019 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

11824 Southwest Hwy
Ste 100
Palos Heights, IL 60463
Phone (708) 361-0222

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

815 Main St
Ste A1
Peoria, IL 61602

900 Main St
Ste 250
Peoria, IL 61602

2300 N Rockton Ave
Rockford, IL 61103

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

Interoperability endpoints

  • Direct secure messaging: ahamdallah229733@direct.myadvocateaurora.org

Organizations & group practices 7

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 6

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": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1053726760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731443",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11824 SOUTHWEST HWY STE 100",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631083",
            "telephone_number": "708-361-0222",
            "fax_number": "708-361-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMDALLAH",
        "first_name": "ABDALLAH",
        "middle_name": "MAHMOUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301104995",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "IL",
            "license": "036.145234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11824 Southwest Hwy Ste 100",
            "city": "Palos Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604631083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahamdallah229733@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11824 Southwest Hwy Ste 100",
            "city": "Palos Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604631083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.