Jacqueline Souza, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

36110540 Issued in IL

Practice address

5215 N California Ave Ste 601
Chicago, IL 60625-8564

Phone

(773) 878-3627

Fax

(773) 989-1669

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  Pediatrics

  Medicare reassignment NPD
• Swedish Covenant Management Services, Inc.

  • Obstetrics & Gynecology Physician
  • Chicago, IL
  • NPI 1760432348

  Pediatrics

  Medicare reassignment NPD
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD
• Swedish Covenant Management Services, Inc

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1962049551
  NPD

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1770636979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 N CALIFORNIA AVE STE 601",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606258564",
            "telephone_number": "773-878-3627",
            "fax_number": "773-989-1669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N CALIFORNIA AVE STE 601",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606258564",
            "telephone_number": "773-878-3627",
            "fax_number": "773-989-1669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Ogden Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605047222",
            "country_code": "US",
            "telephone_number": "630-978-6200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUZA",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "36110540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsouza277062@direct.northshore.org",
            "affiliation": "N",
            "address_1": "5215 N California Ave Ste 601",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606258564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Sovereign Healthcare
• Sovereign Rehabilitation of Chicago, LTD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.