Individual provider Active NPI

Tyler Saunders, DO

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1174018899
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
03615805 Issued in IL
Practice address
5346 N Clark St
Chicago, IL 60640-2120
Phone
(773) 293-8880
Fax
(773) 293-8843
NPI assigned
Jun 25, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 03615805 IL Primary

Addresses

Primary practice location

5346 N Clark St
Chicago, IL 60640-2120

Mailing address

2650 Ridge Ave Ste 1223
Evanston, IL 60201-1700
Phone (773) 293-8880

Other practice location 1

5145 N California Ave
Chicago, IL 60625-3661
Phone (773) 878-8200

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
I20210830003338 IL Practitioner - Internal Medicine 2769888767 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2018
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2650 Ridge Ave
Suite 1223
Evanston, IL 60201-1700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03615805ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Feb 21, 2023 Accepting new patients
Swedish Covenant Management Services, Inc. CurrentSince Aug 19, 2021 Accepting new patients
Endeavor Health Medical Group Internal Medicine CurrentSince Oct 17, 2021 Accepting new patients
Swedish Covenant Management Services, Inc. Internal Medicine Current Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Aug 19, 2021 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

5145 N California Ave
Chicago, IL 60625
Phone (773) 989-3800

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

Organizations & group practices 5

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 2

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": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1174018899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700",
            "telephone_number": "773-293-8880",
            "fax_number": "773-293-8843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5346 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402120",
            "telephone_number": "773-293-8880",
            "fax_number": "773-293-8843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5145 N California Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606253661",
            "country_code": "US",
            "telephone_number": "773-878-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAUNDERS",
        "first_name": "TYLER",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "03615805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.