NPIMap

Individual provider Active NPI

Ejaz Shamim, MD

  • Diagnostic Radiology Physician
  • Morton Grove, IL
National Provider Identifier
1548251069
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036.104277 Issued in IL
Practice address
9224 Nagle Ave
Morton Grove, IL 60053-1428
Phone
(847) 966-7917
NPI assigned
Nov 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036.104277 IL Primary
Diagnostic Radiology Physician 2085R0202X 01057985A IN

Addresses

Primary practice location

9224 Nagle Ave
Morton Grove, IL 60053-1428

Mailing address

9224 Nagle Ave
Morton Grove, IL 60053-1428
Phone (847) 966-7917

Other identifiers 2

IdentifierTypeStateIssuer
200451430MedicaidIN
P00086529OtherINRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070108000416 IL Practitioner - Diagnostic Radiology 5799785127 Reassigns benefits to 2 organizations
I20241218001385 WI Practitioner - Diagnostic Radiology 5799785127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Southern Illinois University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, 1,134 clinicians
Madison Radiologists S CGroup PAC ID 1951209311, 58 clinicians

Practice addresses (Care Compare)

1211 Fish Hatchery Rd
Madison, WI 53715-1909
Phone (608) 252-8000

1740 W Taylor St
Chicago, IL 60612-7232

1801 W Taylor St
Chicago, IL 60612-4795

5525 S Pulaski Rd
Chicago, IL 60629-4400
Phone (312) 996-2779

9224 Nagle Ave
Morton Grove, IL 60053-1428
Phone (614) 340-7740

Hospital & facility affiliations

  • SSM Health St Mary'S Hospital - Madison Hospital, Madison, WI, CCN 520083
  • The Monroe Clinic Hospital, Monroe, WI, CCN 520028
  • SSM Health St Clare Hospital - Baraboo Hospital, Baraboo, WI, CCN 520057
  • Columbus Community Hospital Hospital, Columbus, WI, CCN 521338
  • Southwest Health Center Hospital, Platteville, WI, CCN 521354

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.104277ILMDDiagnostic Radiology Physician
01057985AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Diagnostic Radiology CurrentSince Oct 30, 2006 Accepting new patients
Madison Radiologists S C Diagnostic Radiology CurrentSince Dec 9, 2024 Accepting new patients
Dean Health Systems, Inc CurrentSince Dec 10, 2024 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Dean Health Systems, Inc. CurrentSince Dec 10, 2024 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Oct 30, 2006 Accepting new patients
Endeavor Health Medical Group Past Accepting new patients
Endeavor Health Medical Group Past Accepting new patients

Locations

1740 W Taylor St
#931
Chicago, IL 60612
Phone (312) 355-5258

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

1211 Fish Hatchery Rd
Madison, WI 53715
Phone (608) 252-8000

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

Interoperability endpoints

  • Direct secure messaging: eshamim526580@direct-ehr-ssmhc.com
  • Direct secure messaging: eshamim17464@uihealth.direct-ci.com

Organizations & group practices 51

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.

View all 51

Hospital & facility affiliations 7

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": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1548251069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9224 NAGLE AVE",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600531428",
            "telephone_number": "847-966-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9224 NAGLE AVE",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600531428",
            "telephone_number": "847-966-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMIM",
        "first_name": "EJAZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036.104277",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01057985A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200451430",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00086529",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morton Grove, IL

Sources for this page

Verify at the official NPI Registry.