NPIMap

Individual provider Active NPI

Stathis Poulakidas, MD

  • Surgical Critical Care Physician
  • Libertyville, IL
National Provider Identifier
1508833344
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
36099012 Issued in IL
Practice address
801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone
(847) 362-2900
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036-099012 IL
Trauma Surgery Physician 2086S0127X 36099012 IL
Surgical Critical Care Physician 2086S0102X 36099012 IL Primary

Addresses

Primary practice location

801 S Milwaukee Ave
Libertyville, IL 60048-3204

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

1901 W Harrison St
Room 3229
Chicago, IL 60612-3714
Phone (312) 864-3166

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address spoulakidas@direct.ccprovider.org Direct Cook County
Direct Messaging Address spoulakidas333485@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20031229000098 IL Practitioner - Critical Care (Intensivists)Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology)Practitioner - Emergency Medicine 9537067608 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Colorectal Surgery (Proctology), Emergency Medicine, General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

500 E 51St St
Chicago, IL 60615-2494
Phone (312) 572-2000

5668 E State St
Rockford, IL 61108-2464
Phone (815) 397-7900

Hospital & facility affiliations

  • John H Stroger Jr Hospital Hospital, Chicago, IL, CCN 140124
  • Saint Anthony Medical Center Hospital, Rockford, IL, CCN 140233

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-099012ILMDSurgery Physician
36099012ILMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Jan 31, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 31, 2022 Accepting new patients
Cook County CurrentSince Sep 6, 2006 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Cook County Surgery CurrentSince Sep 6, 2006 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
Colusa Emergency Physicians Medical Group, Inc. Past Accepting new patients
Oakdale Medical Group Inc Past Accepting new patients

Locations

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Rm 3229
Chicago, IL 60612
Phone (312) 864-2744

29373 Network Pl
Chicago, IL 60673

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

25706 Network Pl
Chicago, IL 60673

4909 W Division St
Chicago, IL 60651
Phone (773) 854-8000

420 W Butterfield Rd
Elmhurst, IL 60126
Phone (630) 832-2300

801 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-2900

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1001 Main St
Ste 400
Peoria, IL 61606
Phone (309) 308-0920

5668 E State St
#400
Rockford, IL 61108
Phone (815) 398-7755

535 Roxbury Rd
Rockford, IL 61107
Phone (815) 387-1717

698 Featherstone Rd
Rockford, IL 61107
Phone (815) 398-3277

5668 E State St
Rockford, IL 61108
Phone (815) 229-7580

5666 E State St
Rockford, IL 61108
Phone (815) 226-2000

1400 W Park St
Urbana, IL 61801
Phone (217) 337-2000

Interoperability endpoints

  • Direct secure messaging: spoulakidas@direct.ccprovider.org

Organizations & group practices 10

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 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1508833344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483204",
            "telephone_number": "847-362-2900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 W Harrison St",
            "address_2": "Room 3229",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123714",
            "country_code": "US",
            "telephone_number": "312-864-3166",
            "fax_number": "312-864-9545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULAKIDAS",
        "first_name": "STATHIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-099012",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "IL",
            "license": "36099012",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IL",
            "license": "36099012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spoulakidas@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spoulakidas333485@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "801 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "801 S Milwaukee Ave",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600483204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.