Individual provider Active NPI

Sang Han, MD

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1629011630
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036-059209 Issued in IL
Practice address
3435 W Van Buren St
Chicago, IL 60624-3312
Phone
(773) 265-4571
NPI assigned
Jun 14, 2006
Last updated
Feb 4, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-059209 IL Primary

Addresses

Primary practice location

3435 W Van Buren St
Chicago, IL 60624-3312

Mailing address

34404 Eagle Way
Chicago, IL 60678-1344
Phone (630) 734-0200

Other identifiers 2

IdentifierTypeStateIssuer
036059209MedicaidIL
036059209-2MedicaidIL

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
I20040522000103 IL Practitioner - Emergency Medicine 7517856099 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-059209ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Township Hospital CurrentSince Jul 1, 2010 Accepting new patients
Washington County Hospital District CurrentSince May 1, 2015 Accepting new patients
Salem Township Hospital CurrentSince Jul 1, 2010 Accepting new patients
Washington County Hospital District CurrentSince May 1, 2015 Accepting new patients
Acute Care Specialists, Inc. Emergency Medicine Past Accepting new patients
Emergency Medical Specialists, II, S.C. Emergency Medicine Past Accepting new patients
Salem Township Hospital Past Accepting new patients

Locations

705 S Grand St
Nashville, IL 62263
Phone (618) 327-2200

1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194

Organizations & group practices 7

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265241600000",
    "number": "1629011630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34404 EAGLE WAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606781344",
            "telephone_number": "630-734-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 W VAN BUREN ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606243312",
            "telephone_number": "773-265-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAN",
        "first_name": "SANG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2010-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-059209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036059209",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036059209-2",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.