Individual provider Active NPI

Courtney Kimi Suh, MD

  • Family Medicine Physician
  • Maywood, IL
National Provider Identifier
1528266566
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036122014 Issued in IL
Practice address
1211 W Roosevelt Rd
Maywood, IL 60153-4046
Phone
(708) 531-5200
Fax
(708) 531-7915
NPI assigned
Jul 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125051006 IL
Family Medicine Physician 207Q00000X 036122014 IL Primary

Addresses

Primary practice location

1211 W Roosevelt Rd
Maywood, IL 60153-4046

Mailing address

1211 W Roosevelt Rd
Maywood, IL 60153-4046
Phone (708) 531-5200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address csuh53027@direct.luhs.org Direct LOYOLA UNIVERSITY MEDICAL CENTER

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091104000564 IL Practitioner - Family Practice 0648318030 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Loyola University Medical CenterGroup PAC ID 3779488903, 917 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

2600 Compass Rd
Glenview, IL 60026-8001

7255 W Grand Ave
Elmwood Park, IL 60707-2028
Phone (708) 327-1650

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036122014ILMDFamily Medicine Physician
125051006ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Apr 3, 2013 Accepting new patients
PCC Community Wellness Center CurrentSince Aug 4, 2009 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Loyola University Medical Center CurrentSince Apr 3, 2013 Accepting new patients
PCC Community Wellness Center CurrentSince Aug 4, 2009 Accepting new patients

Locations

7255 W Grand Ave
Elmwood Park, IL 60707
Phone (708) 452-5809

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

1211 W Roosevelt Rd
Maywood, IL 60153
Phone (708) 531-5200

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

2 Westbrook Corporate Ctr
Ste 600
Westchester, IL 60154
Phone (708) 216-5092

Organizations & group practices 6

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 3

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1528266566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 W ROOSEVELT RD",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601534046",
            "telephone_number": "708-531-5200",
            "fax_number": "708-531-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W ROOSEVELT RD",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601534046",
            "telephone_number": "708-531-5200",
            "fax_number": "708-531-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUH",
        "first_name": "COURTNEY",
        "middle_name": "KIMI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125051006",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036122014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csuh53027@direct.luhs.org",
            "affiliation": "Y",
            "affiliationName": "LOYOLA UNIVERSITY MEDICAL CENTER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S 1st Ave",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.