Active NPI
Mohammed Samiruddin, M.D.
- Family Medicine Physician
- Villa Park, IL
National Provider Identifier
1144432188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-122142
- Practice address
- 622 N Addison Rd
Villa Park, IL 60181-1419 - Phone
- (630) 279-9600
- Fax
- (630) 279-9602
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-122142 | IL | Primary |
Addresses
Primary practice location
622 N Addison Rd
Villa Park, IL 60181-1419
Mailing address
PO Box 1897
Lombard, IL 60148-8897
Phone (630) 279-9600
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00858156 | Other | IL | RAILROAD MEDICARE |
| 036122142 | Medicaid | IL | |
| 11928895 | Other | IL | CAQH |
| 14D1096717 | Other | IL | CLIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-122142 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acute Care Specialists II, LTD | Past | Accepting new patients |
Organizations & group practices 1
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.
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- NPI 1205974433
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1144432188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1897",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601488897",
"telephone_number": "630-279-9600",
"fax_number": "630-279-9602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 N ADDISON RD",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601811419",
"telephone_number": "630-279-9600",
"fax_number": "630-279-9602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMIRUDDIN",
"first_name": "MOHAMMED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-122142",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00858156",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036122142",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11928895",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "14D1096717",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Villa Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.