Individual provider Active NPI

Kate Lynn Maxouris, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1215986062
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-093187 Issued in IL
Practice address
5140 N California Ave
Suite 635/645
Chicago, IL 60625-3645
Phone
(773) 878-8200
Fax
(773) 878-0788
NPI assigned
May 9, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-093187 IL Primary

Addresses

Primary practice location

5140 N California Ave
Suite 635/645
Chicago, IL 60625-3645

Mailing address

5140 N California Ave
Suite 635/645
Chicago, IL 60625-3645
Phone (773) 878-8200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmaxouris277034@direct.northshore.org

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
I20060907000122 IL Practitioner - Family Practice 3476557331 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Suite 2218a
Evanston, IL 60201-1700
Phone (847) 503-4222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-093187ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Feb 14, 2023 Accepting new patients
Endeavor Health Medical Group Family Medicine CurrentSince Feb 14, 2023 Accepting new patients
Swedish Covenant Management Services, Inc. CurrentSince Aug 1, 2006 Accepting new patients
Swedish Covenant Management Services, Inc. Family Medicine Current Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Aug 1, 2006 Accepting new patients

Locations

251 E Huron St
Chicago, IL 60611

5140 N California Ave
Ste 635645
Chicago, IL 60625
Phone (773) 989-6200

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

5215 N California Ave
Ste 602
Chicago, IL 60625
Phone (773) 878-3627

9532 Eagle Way
Chicago, IL 60678

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 1223
Evanston, IL 60201
Phone (847) 982-3175

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

Interoperability endpoints

  • Direct secure messaging: kmaxouris277034@direct.northshore.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1215986062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 635/645",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-878-8200",
            "fax_number": "773-878-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 635/645",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-878-8200",
            "fax_number": "773-878-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXOURIS",
        "first_name": "KATE LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-09",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-093187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmaxouris277034@direct.northshore.org",
            "affiliation": "N",
            "address_1": "5140 N California Ave",
            "address_2": "SUITE 635/645",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606253645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.