Individual provider Active NPI

Susan Haido, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1285715136
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36-089980 Issued in IL
Practice address
2740 W Foster Ave
Suite # 211
Chicago, IL 60625-3500
Phone
(773) 275-8200
Fax
(773) 275-8555
NPI assigned
Oct 18, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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 36-089980 IL Primary

Addresses

Primary practice location

2740 W Foster Ave
Suite # 211
Chicago, IL 60625-3500

Mailing address

5140 N California Ave
Ste 620
Chicago, IL 60625-3664
Phone (773) 275-8200

Other identifiers 2

IdentifierTypeStateIssuer
364399316OtherILTAX ID COMM PROV #
036089980MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shaido276354@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
I20120904000339 IL Practitioner - Family Practice 3274707302 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

6450 W Touhy Ave
Niles, IL 60714-4512

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Swedish Hospital Hospital, Chicago, IL, CCN 140114

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36-089980ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Covenant Management Services, Inc. Family Medicine CurrentSince Jun 1, 2013 Accepting new patients
Endeavor Health Medical Group CurrentSince Feb 15, 2023 Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Jun 1, 2013 Accepting new patients
Endeavor Health Medical Group Family Medicine CurrentSince Feb 15, 2023 Accepting new patients
P. V. Kurani, MD, SC PastSince Oct 26, 2010 Accepting new patients

Locations

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

9532 Eagle Way
Chicago, IL 60678

5140 N California Ave
Ste 620
Chicago, IL 60625
Phone (312) 952-9692

2740 W Foster Ave
Ste 211
Chicago, IL 60625
Phone (773) 275-8200

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

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

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

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

6450 W Touhy Ave
Niles, IL 60714
Phone (847) 583-1000

6450 W Touhy Ave
Fl 2
Niles, IL 60714
Phone (773) 293-4710

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 and National Provider Directory roles.

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1285715136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "STE 620",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253664",
            "telephone_number": "773-275-8200",
            "fax_number": "773-275-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 W FOSTER AVE",
            "address_2": "SUITE # 211",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253500",
            "telephone_number": "773-275-8200",
            "fax_number": "773-275-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIDO",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36-089980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID COMM PROV #",
            "identifier": "364399316",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036089980",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shaido276354@direct.northshore.org",
            "affiliation": "N",
            "address_1": "2740 W Foster Ave",
            "address_2": "Suite # 211",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606253500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.