Samantha Marie Boburka, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085004138 Issued in IL

Practice address

110 W Calendar Ave
La Grange, IL 60525-2325

Phone

(708) 745-5277

Fax

(708) 579-2408

NPI assigned

Oct 14, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Cullen Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samantha.boburka.1@3547.direct.athenahealth.com

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.

• Rush University Medical Group

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542
  Medicare reassignment NPD
• Rush-Copley Medical Group, NFP

  • Family Medicine Physician
  • Aurora, IL
  • NPI 1093075848
  Medicare reassignment NPD
• Rush University Medical Center

  • Internal Medicine Physician
  • Oak Brook, IL
  • NPI 1801375696
  NPD

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1487939088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 W CALENDAR AVE STE 207",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256327",
            "telephone_number": "708-745-5277",
            "fax_number": "708-579-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W CALENDAR AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252325",
            "telephone_number": "708-745-5277",
            "fax_number": "708-579-2408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5201 Willow Springs Rd",
            "address_2": "Suite 290",
            "address_purpose": "LOCATION",
            "city": "LA Grange Highlands",
            "state": "IL",
            "postal_code": "605256537",
            "country_code": "US",
            "telephone_number": "708-579-0018",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 W Galena Blvd",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605064305",
            "country_code": "US",
            "telephone_number": "630-692-5960",
            "fax_number": "630-692-5961",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBURKA",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-14",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "CULLEN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• BFB Therapeutics, LLC
• Tina Biel, ED.S, NCSP
• Beau Blakeley, DC
• Debra Babb Blakely, RN, LCPC
• Demetrios Bobolos, LAC
• Jerry P Bonet, D.P.M.
• Tracy Bongiorno, P.A.-C
• Christine O'Connor Bonhomme, M.D.
• Kathryn Marie Bonnstetter
• Amy Botta

• Physician Assistant in La Grange, IL
• Providers in La Grange, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.