Individual provider Active NPI

Michael Dennis Amer

  • Neonatal-Perinatal Medicine Physician
  • Evanston, IL
National Provider Identifier
1275615353
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
036069170 Issued in IL
Practice address
2650 Ridge Ave
Division of Neonatology, Walgreen BLDG RM 1505
Evanston, IL 60201-1718
Phone
(847) 570-2033
Fax
(847) 570-0231
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036069170 IL
Neonatal-Perinatal Medicine Physician 2080N0001X 036069170 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Division of Neonatology, Walgreen BLDG RM 1505
Evanston, IL 60201-1718

Mailing address

2650 Ridge Ave
Division of Neonatology, Walgreen BLDG RM 1505
Evanston, IL 60201-1718
Phone (847) 570-2033

Other identifiers 2

IdentifierTypeStateIssuer
036069170MedicaidIL
1620385OtherILBLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mamer6789@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
I20060207000527 IL Practitioner - Pediatric Medicine 4082629431 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036069170ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Covenant Management Services, Inc CurrentSince Jun 1, 2020 Accepting new patients
Swedish Covenant Management Services, Inc. Pediatrics CurrentSince Jun 1, 2020 Accepting new patients
Endeavor Health Medical Group Pediatrics Past Accepting new patients
Endeavor Health Medical Group Past Accepting new patients

Locations

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

2740 W Foster Ave
Ste 310
Chicago, IL 60625

5140 N California Ave
Chicago, IL 60625
Phone (773) 275-8811

Interoperability endpoints

  • Direct secure messaging: mamer234771@direct.myadvocateaurora.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1275615353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "DIVISION OF NEONATOLOGY, WALGREEN BLDG RM 1505",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2033",
            "fax_number": "847-570-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "DIVISION OF NEONATOLOGY, WALGREEN BLDG RM 1505",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2033",
            "fax_number": "847-570-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMER",
        "first_name": "MICHAEL",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036069170",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036069170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036069170",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1620385",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mamer6789@direct.northshore.org",
            "affiliation": "N",
            "address_1": "2650 Ridge Ave",
            "address_2": "Division of Neonatology, Walgreen Bldg Rm 1505",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "602011718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.