Individual provider Active NPI

Suzanne Thi Pham, M.D.

  • Internal Medicine Physician
  • Melrose Park, IL
National Provider Identifier
1659537298
Registry record updated Dec 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125-049355 Issued in IL
Practice address
701 W North Ave
Melrose Park, IL 60160-1612
Phone
(708) 681-3200
NPI assigned
Aug 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125-049355 IL Primary
Pediatrics Physician 208000000X 125-049355 IL

Addresses

Primary practice location

701 W North Ave
Melrose Park, IL 60160-1612

Mailing address

701 W North Ave
Melrose Park, IL 60160-1612
Phone (708) 681-3200

Other identifiers 1

IdentifierTypeStateIssuer
036123286MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Oct 1, 2024 through Oct 1, 2026

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125-049355ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gottlieb Memorial Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: suzanne.pham.1@18552.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1659537298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W NORTH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601612",
            "telephone_number": "708-681-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W NORTH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601612",
            "telephone_number": "708-681-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "SUZANNE",
        "middle_name": "THI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125-049355",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125-049355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036123286",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose Park, IL

Sources for this page

Verify at the official NPI Registry.