Adam David Souchik, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

125077603 Issued in IL

Practice address

2160 S 1St Ave
Fahey BLDG./Room 101
Maywood, IL 60153-3328

Phone

(708) 216-4962

Fax

(708) 216-2444

NPI assigned

Mar 27, 2020

Last updated

Jun 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Dermatology

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalskin Medical Group Il PLLCGroup PAC ID 5991116261, 56 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: asouchik111334@direct.luhs.org

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.

• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Mattoon, IL
  • NPI 1063030252
  Medicare reassignment Care Compare group NPD
• Loyola University Medical Center

  dba Foster G. McGaw Hospital

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  NPD
• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • New Albany, IN
  • NPI 1477297083
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1205464146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 GRANARY RD",
            "city": "BLUE BELL",
            "state": "PA",
            "postal_code": "194222155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "FAHEY BLDG./ROOM 101",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-4962",
            "fax_number": "708-216-2444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "549 Fair St # Mc61-22",
            "address_purpose": "LOCATION",
            "city": "Bloomsburg",
            "state": "PA",
            "postal_code": "178151419",
            "country_code": "US",
            "telephone_number": "570-416-1925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUCHIK",
        "first_name": "ADAM",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "125077603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert Jae Song, M.D.
• Paige T Song, MD
• Isaac Sontag-Milobsky
• Chandana Sooranahalli
• Rafal Leszek Sosnowski, D.O.
• Michael Clarkston Soult II, MD
• Laurel Anna Spaccarelli, MD
• Justin Spackey, MD
• Jodi J Speiser, M.D.
• Spine and Joint Rehabilitation Services

• Dermatology Physician in Maywood, IL
• Providers in Maywood, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.

Verify at the official NPI Registry.