Michael D Coulson, D.O.
Individual provider Active NPI Anesthesiology Physician · Dekalb, IL
NPI 1255338554 · NPPES record last updated Jul 14, 2010
Key facts
- NPI
- 1255338554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 036.077834 (IL)
- Practice address
- 1 Kish Hospital Drive
Dekalb, IL 60115-9602 - Phone
- (815) 756-1521
- Fax
- (815) 748-8395
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Ohio Medical University, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Anesthesia Associates, LTD
Practice addresses (Care Compare)
1 Kish Hospital Dr
Dekalb, IL 60115-9602
100 5TH St
Oswego, IL 60543-8338
Phone (630) 449-0085
1325 N Highland Ave
Aurora, IL 60506-1449
Phone (630) 859-2222
825 S Milwaukee Ave
Libertyville, IL 60048-3218
Phone (224) 504-2200
Hospital & facility affiliations
- Presence Mercy Medical Center
- Northwestern Medicine Kishwaukee Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040320000151 | IL | Practitioner - Anesthesiology |
6103727664 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.077834 | IL | MD | Anesthesiology Physician |
| 336.040926 | IL | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Pain Care Centers LTD | Pain Medicine | Current |
Accepting new patients |
| Anesthesia Associates, LTD | Pain Medicine | Current |
Accepting new patients |
Locations
1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756
1222 N Eola Rd
Aurora, IL 60502
Phone (630) 499-8804
626 Bethany Rd
DeKalb, IL 60115
Phone (815) 306-2700
1 Kish Hospital Dr
DeKalb, IL 60115
Phone (815) 754-1521
100 5th St
Oswego, IL 60543
Phone (630) 449-0085
1879 N Neltnor Blvd
West Chicago, IL 60185
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 036077834 | IL | |
| Anesthesiology Physician | 207L00000X | 036.077834 | IL | Yes |
| Anesthesiology Physician | 207L00000X | 336.040926 | IL |
Addresses
Primary practice location
1 Kish Hospital Drive
Dekalb, IL 60115-9602
Mailing address
1 Kish Hospital Drive
Dekalb, IL 60115-9602
Phone (815) 756-1521
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036077834 | Medicaid | IL | |
| 050082135 | Other | IL | RAILROAD MEDICARE |
Other providers in Dekalb, IL
- Comprehensive Rehabilitation Services, Inc
- Consultants in Diagnostic Imaging SC
- Casey R Conway
- Daniel Coomes
- Coral Pediatric Therapy LLC
- Jennifer Helen Courtney
- Kristina Cox
- Nicole Lyn Cox
- Rukisha Lajoy Crawford
- Creative Therapeutics, LTD.
All providers in Dekalb, IL · Anesthesiology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.