NPIMap

Individual provider Active NPI

Ryan Joseph Haskamp, M.D.

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1427430446
Registry record updated Dec 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036147095 Issued in IL
Practice address
2875 W 19TH St
Chicago, IL 60623-3501
Phone
(773) 484-1000
NPI assigned
Jun 25, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036147095 IL Primary

Addresses

Primary practice location

2875 W 19TH St
Chicago, IL 60623-3501

Mailing address

2020 Delmar Blvd
Apt # N502
Saint Louis, MO 63103-1655
Phone (660) 728-2345

Other practice location 1

3635 Vista Ave
Saint Louis, MO 63110-2539
Phone (314) 577-8000

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
I20181119000208 IL Practitioner - Emergency Medicine 5092017491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Missouri, Kansas City, School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Anthony Emergency Services Physician GroupGroup PAC ID 5698744076, 15 clinicians

Practice addresses (Care Compare)

2875 W 19TH St
Chicago, IL 60623-3501
Phone (773) 484-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036147095ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Anthony Emergency Services Physician Group CurrentSince Mar 2, 2024 Accepting new patients
Mea Chicago PC Emergency Medicine CurrentSince Sep 30, 2018 Accepting new patients

Locations

2875 W 19th St
Chicago, IL 60623
Phone (773) 484-4300

Organizations & group practices 2

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 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": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543708800000",
    "number": "1427430446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 DELMAR BLVD",
            "address_2": "APT # N502",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031655",
            "telephone_number": "660-728-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 W 19TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233501",
            "telephone_number": "773-484-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3635 Vista Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631102539",
            "country_code": "US",
            "telephone_number": "314-577-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HASKAMP",
        "first_name": "RYAN",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-25",
        "last_updated": "2018-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036147095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.