Samuel Solomon, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

36039961 Issued in IL

Practice address

103 S Greenleaf St
Suite J
Gurnee, IL 60031-3380

Phone

(847) 662-8201

Fax

(847) 662-8215

NPI assigned

May 23, 2006

Last updated

Feb 12, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Suburban Dermatology Associates,SC

  • Specialist
  • Gurnee, IL
  • NPI 1609827237
  Authorized official Same address or phone

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202774400000",
    "number": "1558316281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S GREENLEAF ST",
            "address_2": "SUITE J",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313380",
            "telephone_number": "847-662-8201",
            "fax_number": "847-662-8215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S GREENLEAF ST",
            "address_2": "SUITE J",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313380",
            "telephone_number": "847-662-8201",
            "fax_number": "847-662-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLOMON",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "36039961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL NO.",
            "identifier": "K39549",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6945148002",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1609827237",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4044905",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN PROVIDER",
            "identifier": "89-101",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "O4920144",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.