Timothy Charles Samelson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036-084135 Issued in IL

Practice address

1425 N Hunt Club Rd Ste 204
Gurnee, IL 60031-2635

Phone

(847) 855-2997

Fax

(847) 855-8347

NPI assigned

Jul 27, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1750381273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 204",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312635",
            "telephone_number": "847-855-2997",
            "fax_number": "847-855-8347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N HUNT CLUB RD STE 204",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312635",
            "telephone_number": "847-855-2997",
            "fax_number": "847-855-8347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMELSON",
        "first_name": "TIMOTHY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-27",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-084135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364050769-60031-01",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tsamelson236522@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1425 N Hunt Club Rd Ste 204",
            "city": "Gurnee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600312635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1425 N Hunt Club Rd Ste 204",
            "city": "Gurnee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600312635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatrics Physician in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.