NPIMap

Individual provider Active NPI

Samreen Fathima, MD

  • Hematology (Pathology) Physician
  • Maywood, IL
National Provider Identifier
1275094518
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology (Pathology) PhysicianTaxonomy code 207ZH0000X
License
036165508 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone
(708) 216-9000
NPI assigned
Mar 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Hematology (Pathology) Physician 207ZH0000X 036165508 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153-3328

Mailing address

3500 Gaston Ave
Dallas, TX 75246-2088
Phone (214) 820-2361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20240704000423 MN Practitioner - Pathology 7517328651 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1700 University Ave W
6TH Floor W
Saint Paul, MN 55104-3727
Phone (651) 232-2273

2450 Riverside Ave
Minneapolis, MN 55454-1450

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Merit-based Incentive Payment System (MIPS)

Final score
92.68 of 100Reported as group
Quality
89.73
Promoting interoperability
100
Improvement activities
40
Cost
80.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Physicians CurrentSince Aug 16, 2024 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care CurrentSince Aug 16, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Aug 16, 2024 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Aug 16, 2024 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Jul 26, 2024 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Jul 26, 2024 Accepting new patients
Fairview Express Care CurrentSince Aug 16, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 16, 2024 Accepting new patients

Locations

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

720 Washington Ave SE
Ste 200
Minneapolis, MN 55414
Phone (612) 730-1345

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Organizations & group practices 11

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 8

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": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1275094518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462088",
            "telephone_number": "214-820-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATHIMA",
        "first_name": "SAMREEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-28",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "IL",
            "license": "036165508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.