Individual provider Active NPI

Sara Ann Kullberg Pearson, MD

  • Dermatopathology Physician
  • Chicago, IL
National Provider Identifier
1508445487
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
125085121 Issued in IL
Practice address
676 N Saint Clair St Ste 1600
Chicago, IL 60611-2997
Phone
(312) 695-8106
Fax
(312) 695-0664
NPI assigned
Apr 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dermatopathology Physician 207ND0900X 125085121 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 1600
Chicago, IL 60611-2997

Mailing address

676 N Saint Clair St Ste 1600
Chicago, IL 60611-2997
Phone (312) 695-8106

Other practice location 1

420 Delaware Street SE, MMC 98
Minneapolis, MN 55455
Phone (612) 624-9964

Other practice location 2

1836 South Ave
LA Crosse, WI 54601-5429
Phone (608) 782-7300

Other names 1

  • Sara Ann Kullberg Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125085121ILMDDermatopathology Physician
32891MNMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation PastSince Aug 3, 2025 Accepting new patients
Central Dupage Physician Group PastSince Aug 3, 2025 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1508445487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112997",
            "telephone_number": "312-695-8106",
            "fax_number": "312-695-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112997",
            "telephone_number": "312-695-8106",
            "fax_number": "312-695-0664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware Street SE, MMC 98",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55455",
            "country_code": "US",
            "telephone_number": "612-624-9964",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KULLBERG PEARSON",
        "first_name": "SARA",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-07",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "IL",
            "license": "125085121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "KULLBERG",
            "middle_name": "ANN",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.