Individual provider Active NPI

Michael D Scott, MD

  • Emergency Medicine Physician
  • Downers Grove, IL
National Provider Identifier
1790763571
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036100296 Issued in IL
Practice address
5404 Fairview Ave
Downers Grove, IL 60515-5332
Phone
(630) 921-1606
NPI assigned
Jan 3, 2006
Last updated
May 13, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2009

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 036100296 IL Primary

Addresses

Primary practice location

5404 Fairview Ave
Downers Grove, IL 60515-5332

Mailing address

5404 Fairview Ave
Downers Grove, IL 60515-5332
Phone (630) 921-1606

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
I20060505000029 IL Practitioner - Emergency Medicine 7214911049 Reassigns benefits to 5 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14368ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Statera Health Care, LLC Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
App of Illinois Ed PLLC Emergency Medicine CurrentSince Aug 17, 2021 Accepting new patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Integritas Emergency Physician Services, LLC Emergency Medicine CurrentSince Sep 1, 2013 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Dec 8, 2017 Accepting new patients
Memorial Hospital Current Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Dec 8, 2017 Accepting new patients
Paragon Contracting Services LLC Emergency Medicine Past Accepting new patients

Locations

517 N Main St
Anna, IL 62906
Phone (618) 833-2295

201 Bailey Ln
Benton, IL 62812
Phone (618) 438-3113

2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691

1900 State St
Chester, IL 62233
Phone (618) 826-2388

3333 W Deyoung St
Marion, IL 62959
Phone (618) 998-7020

611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146

650 W Taylor St
Vandalia, IL 62471
Phone (618) 283-1231

1324 N Sheridan Rd
Waukegan, IL 60085
Phone (847) 360-3000

Interoperability endpoints

  • Direct secure messaging: mscott@yourcarecommunity.org

Organizations & group practices 8

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": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242172800000",
    "number": "1790763571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 FAIRVIEW AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155332",
            "telephone_number": "630-921-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5404 FAIRVIEW AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155332",
            "telephone_number": "630-921-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2009-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036100296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

Verify at the official NPI Registry.