Individual provider Active NPI

Wendy Kim, DO

  • Dermatology Physician
  • Maywood, IL
National Provider Identifier
1790930477
Registry record updated Mar 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036130097 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone
(708) 216-9000
NPI assigned
Nov 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 036130097 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153-3328

Mailing address

1600 S Prairie Ave
2108
Chicago, IL 60616-1360

Other names 1

  • Wendy Schumacher Former name

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
I20130722000167 IL Practitioner - Dermatology 8729229570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Midwestern University, Chicago College of Osteopathic Med, 2008
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)

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

Hospital & facility affiliations

  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision14
Removal of skin lesions403
Skin biopsy260

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036130097ILMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center Current Accepting new patients
Loyola University Medical Center CurrentSince Sep 1, 2013 Accepting new patients
Loyola University Medical Center CurrentSince Sep 1, 2013 Accepting new patients

Locations

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

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

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

Interoperability endpoints

  • Direct secure messaging: wschumacher55611@direct.luhs.org

Organizations & group practices 3

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 2

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": "1227398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426118400000",
    "number": "1790930477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S PRAIRIE AVE",
            "address_2": "2108",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "WENDY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-23",
        "last_updated": "2015-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036130097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WENDY",
            "last_name": "SCHUMACHER",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.