NPIMap

Individual provider Active NPI

Suresh Nelson Samson, M.D

  • Nephrology Physician
  • Olympia Fields, IL
National Provider Identifier
1265685242
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036-132030 Issued in IL
Practice address
3302 Vollmer Rd
Olympia Fields, IL 60461-1179
Phone
(708) 898-0811
NPI assigned
Nov 4, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036-132030 IL Primary

Addresses

Primary practice location

3302 Vollmer Rd
Olympia Fields, IL 60461-1179

Mailing address

PO Box 3877
Joliet, IL 60434-3877
Phone (815) 741-6830

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ssamson275998@direct.myadvocateaurora.org Direct
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130926000131 IL Practitioner - NephrologyPractitioner - Internal Medicine 9739323254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kidney Care Center Olympia Fields LLCGroup PAC ID 2163640533, 7 clinicians

Practice addresses (Care Compare)

3302 Vollmer Rd
Olympia Fields, IL 60461-1179
Phone (708) 898-0811

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-132030ILMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Care Center Olympia Fields LLC Nephrology CurrentSince Jul 1, 2014 Accepting new patients
Home Dialysis Services Olympia Fields LLC Past Accepting new patients
Dialysis Care Center Olympia Fields LLC Past Accepting new patients

Locations

2315 E 93rd St
Ste 239
Chicago, IL 60617
Phone (219) 472-0379

16540 Halsted St
Ste A
Harvey, IL 60426
Phone (708) 898-0811

3322 Vollmer Rd
Ste B
Olympia Fields, IL 60461

3322 Vollmer Rd
Ste C
Olympia Fields, IL 60461
Phone (708) 964-2250

3322 Vollmer Rd
Ste A
Olympia Fields, IL 60461
Phone (708) 898-1245

3302 Vollmer Rd
Olympia Flds, IL 60461
Phone (708) 864-2006

Interoperability endpoints

  • Direct secure messaging: ssamson275998@direct.myadvocateaurora.org
  • Direct secure messaging: ssamson161162@direct.franciscanalliance.org

Organizations & group practices 3

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 11

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": "1225756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1265685242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3877",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604343877",
            "telephone_number": "815-741-6830",
            "fax_number": "815-741-6832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 VOLLMER RD",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611179",
            "telephone_number": "708-898-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMSON",
        "first_name": "SURESH",
        "middle_name": "NELSON",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-04",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036-132030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssamson275998@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3302 Vollmer Rd",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611179",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3302 Vollmer Rd",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611179",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

Verify at the official NPI Registry.