Susan M Ichelle Fanapour, D.O.
Individual provider Active NPI Diagnostic Radiology Physician · Hinsdale, IL
NPI 1568463586 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1568463586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 036105985 (IL)
- Practice address
- 120 N. Oak Street
Hinsdale, IL 60521 - Phone
- (630) 856-9000
- NPI assigned
- Aug 2, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Midwestern University, Chicago College of Osteopathic Med, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Suburban Radiologists, S.C.
Practice addresses (Care Compare)
5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-9000
Hospital & facility affiliations
- Uchicago Medicine Adventhealth la Grange
- Uchicago Medicine Adventhealth Hinsdale
- Uchicago Medicine Adventhealth Bolingbrook
- Uchicago Medicine Adventhealth Glenoaks
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050805000034 | IL | Practitioner - Diagnostic Radiology | 2668434226 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036105985 | IL | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suburban Radiologists, S.C. | Diagnostic Radiology | Current |
Accepting new patients |
| Associated Imaging Specialists | Diagnostic Radiology | Current |
Accepting new patients |
Locations
1446 Momentum Pl
Chicago, IL 60689
1121 Lake Cook Rd
Ste M
Deerfield, IL 60015
Phone (847) 945-4550
77 N Airlite St
Elgin, IL 60123
Phone (847) 622-3407
5101 Willow Springs Rd
Lagrange Hlds, IL 60525
Phone (708) 245-4073
607 Academy Dr
Northbrook, IL 60062
120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 036105985 | IL | Yes |
Addresses
Primary practice location
120 N. Oak Street
Hinsdale, IL 60521
Mailing address
1200 Harger Rd Ste 408
Oak Brook, IL 60523-1818
Phone (630) 472-8800
Other providers in Hinsdale, IL
- Francis R Facchini
- Marc Ruffino Fajardo
- Jodi A Faley
- Family Dental Hinsdale
- Family Health Care, S.C.
- Betty Fang
- Marissa Fang
- Sharon Fang
- Sara Smiley Farrero
- Fashioned Health
All providers in Hinsdale, IL · Diagnostic Radiology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.