Individual provider Active NPI

Matt Vatanatunyakum

  • Family Nurse Practitioner
  • Schaumburg, IL
National Provider Identifier
1821766221
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209025739 Issued in IL
Practice address
519 S Roselle Rd
Schaumburg, IL 60193-2925
Phone
(847) 985-0600
Fax
(847) 985-3786
NPI assigned
Aug 31, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209025739 IL Primary

Addresses

Primary practice location

519 S Roselle Rd
Schaumburg, IL 60193-2925

Mailing address

519 S Roselle Rd
Schaumburg, IL 60193-2925
Phone (847) 985-0600

Other practice location 1

5700 S Maryland Ave
Chicago, IL 60637-1426
Phone (888) 824-0200

Other identifiers 1

IdentifierTypeStateIssuer
209025739OtherILSTATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL mvatan2@uic.edu Direct

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221129001844 IL Practitioner - Nurse Practitioner 7416325295 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, 1,134 clinicians

Practice addresses (Care Compare)

1309 S Halsted St
Chicago, IL 60607-5003
Phone (312) 413-3000

Hospital & facility affiliations

  • University of Illinois Hospital and Clinics Hospital, Chicago, IL, CCN 140150

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Jun 5, 2023 Accepting new patients
Northwest Community Health Services Inc CurrentSince Oct 24, 2022 Accepting new patients
Northwest Community Health Services Inc CurrentSince Oct 24, 2022 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jun 5, 2023 Accepting new patients
Board of Trustees of the University of Illinois Past Accepting new patients
Endeavor Health Medical Group PastSince Sep 1, 2021 Accepting new patients

Locations

3040 W Salt Creek Ln
Arlington Heights, IL 60005
Phone (847) 618-3481

1051 W Rand Rd
Arlington Hts, IL 60004
Phone (847) 221-4601

1450 Busch Pkwy
Buffalo Grove, IL 60089
Phone (847) 459-7860

1309 S Halsted St
Chicago, IL 60607
Phone (312) 413-3000

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

25233 Network Pl
Chicago, IL 60673

7732 Solutions Ctr
Chicago, IL 60677

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

1801 W Taylor St
Chicago, IL 60612
Phone (312) 355-1700

21481 N Rand Rd
Kildeer, IL 60047
Phone (847) 618-9696

519 S Roselle Rd
Schaumburg, IL 60193
Phone (847) 618-0535

Interoperability endpoints

  • Direct secure messaging: mvatanatunyakum96426@uihealth.direct-ci.com

Organizations & group practices 7

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": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1821766221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 S ROSELLE RD",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601932925",
            "telephone_number": "847-985-0600",
            "fax_number": "847-985-3786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 S ROSELLE RD",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601932925",
            "telephone_number": "847-985-0600",
            "fax_number": "847-985-3786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5700 S Maryland Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606371426",
            "country_code": "US",
            "telephone_number": "888-824-0200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VATANATUNYAKUM",
        "first_name": "MATT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-31",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209025739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "209025739",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mvatan2@uic.edu",
            "affiliation": "N",
            "endpointDescription": "school",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "5700 S. Maryland Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

Verify at the official NPI Registry.