NPIMap

Individual provider Active NPI

Samantha Ikeda Ing

  • Geriatric Medicine (Internal Medicine) Physician
  • Chicago, IL
National Provider Identifier
1306328661
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
036.164102 Issued in IL
Practice address
5841 S Maryland Ave Ste Mc6098
Chicago, IL 60637-1448
Phone
(773) 702-0963
NPI assigned
Sep 4, 2018
Reactivated
Apr 15, 2020
Last updated
Jun 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036.164102 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave Ste Mc6098
Chicago, IL 60637-1448

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

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
I20240822001334 IL Practitioner - Geriatric Medicine 3577002518 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Oregon Health Sciences University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.164102ILMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince Jul 8, 2024 Accepting new patients
The University of Chicago Medical Center CurrentSince Jul 8, 2024 Accepting new patients
University of Chicago CurrentSince Jul 8, 2024 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

180 Harvester Dr
Ste 110
Burr Ridge, IL 60527
Phone (773) 702-1061

5841 S Maryland Ave
Ste MC6098
Chicago, IL 60637
Phone (773) 702-8840

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: samantha.ing.1@20978.direct.athenahealth.com
  • Direct secure messaging: sing233847@uchospital.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1306328661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE STE MC6098",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371448",
            "telephone_number": "773-702-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ING",
        "first_name": "SAMANTHA",
        "middle_name": "IKEDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-04",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "deactivation_date": "2020-04-02",
        "reactivation_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036.164102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.