Individual provider Active NPI

Aya Kaddoura

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1063162519
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036173118 Issued in IL
Practice address
355 E Grand Ave
Chicago, IL 60611-5389
Phone
(888) 824-0200
NPI assigned
Mar 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036173118 IL Primary

Addresses

Primary practice location

355 E Grand Ave
Chicago, IL 60611-5389

Mailing address

2712 W Cortland St BSMT
Chicago, IL 60647-0211
Phone (925) 730-9838

Other practice location 1

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200

Other practice location 2

13540 Hull Street Rd
Midlothian, VA 23112-2107
Phone (804) 739-6142

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20251027004137 IL Practitioner - Family Practice 1658860093 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of ChicagoGroup PAC ID 7719899426, shared by 2 NPIs, 1,674 clinicians

Practice addresses (Care Compare)

355 E Grand Ave
Chicago, IL 60611-5389

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036173118ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Chicago CurrentSince Sep 29, 2025 Accepting new patients
The University of Chicago Medical Center CurrentSince Sep 29, 2025 Accepting new patients
University of Chicago CurrentSince Sep 29, 2025 Accepting new patients
The University of Chicago Medical Center CurrentSince Sep 29, 2025 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

47 W Polk St
Ste G1
Chicago, IL 60605
Phone (312) 567-6700

355 E Grand Ave
Chicago, IL 60611
Phone (312) 587-3432

17805 Halsted St
Homewood, IL 60430
Phone (708) 333-2300

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: akaddoura351110@uchospital.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1063162519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 W CORTLAND ST BSMT",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606470211",
            "telephone_number": "925-730-9838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 E GRAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115389",
            "telephone_number": "888-824-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5841 S Maryland Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606371443",
            "country_code": "US",
            "telephone_number": "888-824-0200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13540 Hull Street Rd",
            "address_purpose": "LOCATION",
            "city": "Midlothian",
            "state": "VA",
            "postal_code": "231122107",
            "country_code": "US",
            "telephone_number": "804-739-6142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KADDOURA",
        "first_name": "AYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-28",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036173118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.