Individual provider Active NPI

Matthew R Hagerman, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1811573256
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036169109 Issued in IL
Practice address
1460 N Halsted St Ste 504
Chicago, IL 60642-2613
Phone
(312) 926-3627
Fax
(312) 926-3231
NPI assigned
Mar 23, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036169109 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1460 N Halsted St Ste 504
Chicago, IL 60642-2613

Mailing address

1215 Lee St
Mail Stop 800499
Charlottesville, VA 22908-0816
Phone (434) 924-5348

Other practice location 1

1215 Lee St
Mail Stop 800499
Charlottesville, VA 22908-0816
Phone (434) 924-5348

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
I20240912002425 IL Practitioner - Family Practice 2961803820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Virginia School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1460 N Halsted St
Suite 504
Chicago, IL 60642-2613
Phone (312) 926-6146

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036169109ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2024 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2024 Accepting new patients
Central Dupage Physician Group Family Medicine Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

1460 N Halsted St
Ste 504
Chicago, IL 60642
Phone (312) 694-1097

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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 1

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": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1811573256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 LEE ST",
            "address_2": "MAIL STOP 800499",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 N HALSTED ST STE 504",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422613",
            "telephone_number": "312-926-3627",
            "fax_number": "312-926-3231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 Lee St",
            "address_2": "Mail Stop 800499",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229080816",
            "country_code": "US",
            "telephone_number": "434-924-5348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGERMAN",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-23",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036169109",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.