Individual provider Active NPI

Pauline Camacho, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Maywood, IL
National Provider Identifier
1730168816
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
36097415 Issued in IL
Practice address
2160 S 1St Ave
(McGaw ENT., RM. 47)
Maywood, IL 60153
Phone
(708) 216-5221
Fax
(708) 216-5285
NPI assigned
Jan 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 36097415 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
(McGaw ENT., RM. 47)
Maywood, IL 60153

Mailing address

2160 S 1St Ave
(McGaw ENT., RM. 47)
Maywood, IL 60153
Phone (708) 216-5221

Other identifiers 1

IdentifierTypeStateIssuer
36097415MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pcamacho13758@direct.luhs.org

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
I20050804000364 IL Practitioner - EndocrinologyPractitioner - Internal Medicine 5890724413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Loyola University Medical CenterGroup PAC ID 3779488903, 917 clinicians

Practice addresses (Care Compare)

1 S260 Summit Ave
Oakbrook Terrace, IL 60181-3941
Phone (630) 953-6600

17901 S la Grange Rd
Tinley Park, IL 60487-7226
Phone (708) 327-8300

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

300 N York Rd
Elmhurst, IL 60126-2318
Phone (630) 833-0630

6800 N Frontage Rd
Burr Ridge, IL 60527-7819
Phone (708) 327-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36097415ILMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince Jan 1, 2009 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Loyola University Medical Center CurrentSince Jan 1, 2009 Accepting new patients
Loyola University Physician Foundation Past Accepting new patients

Locations

6800 N Frontage Rd
Burr Ridge, IL 60527
Phone (708) 327-1000

420 W Butterfield Rd
Elmhurst, IL 60126
Phone (630) 832-2300

500 W Court St
Kankakee, IL 60901
Phone (800) 585-4119

2160 S 1st Ave
Rm 47
Maywood, IL 60153
Phone (708) 216-5221

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

1S260 Summit Ave
Oakbrook Terrace, IL 60181
Phone (630) 953-6600

2 Westbrook Corporate Ctr
Ste 600
Westchester, IL 60154
Phone (708) 216-5092

Organizations & group practices 4

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1730168816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "(MCGAW ENT., RM. 47)",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-5221",
            "fax_number": "708-216-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "(MCGAW ENT., RM. 47)",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-5221",
            "fax_number": "708-216-5285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "PAULINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-17",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": "36097415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36097415",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcamacho13758@direct.luhs.org",
            "affiliation": "N",
            "address_1": "2160 S 1st Ave",
            "address_2": "(MCGAW ENT., RM. 47)",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.