Individual provider Active NPI

Ehab M Shams, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1568453876
Registry record updated Jan 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036094256 Issued in IL
Practice address
7447 W. Talcott Ave
Suite 512
Chicago, IL 60631
Phone
(773) 774-1790
Fax
(773) 774-1796
NPI assigned
Nov 4, 2005
Last updated
Jan 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036094256 IL Primary

Addresses

Primary practice location

7447 W. Talcott Ave
Suite 512
Chicago, IL 60631

Mailing address

7447 W. Talcott Ave
Suite 512
Chicago, IL 60631
Phone (773) 774-1790

Other identifiers 1

IdentifierTypeStateIssuer
036094256MedicaidIL

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
I20090824000556 IL Practitioner - Internal Medicine 9133144975

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036094256ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Hope Medical Group of Illinois PLLC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1568453876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7447 W. TALCOTT AVE",
            "address_2": "SUITE 512",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60631",
            "telephone_number": "773-774-1790",
            "fax_number": "773-774-1796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7447 W. TALCOTT AVE",
            "address_2": "SUITE 512",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60631",
            "telephone_number": "773-774-1790",
            "fax_number": "773-774-1796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMS",
        "first_name": "EHAB",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036094256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036094256",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.