Individual provider Active NPI

Luma Sukkar, M.D.

  • Family Medicine Physician
  • Waukegan, IL
National Provider Identifier
1831352038
Registry record updated Dec 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.127489 Issued in IL
Practice address
3010 Grand Ave
Waukegan, IL 60085-2321
Phone
(847) 377-8180
NPI assigned
Jul 8, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.127489 IL Primary

Addresses

Primary practice location

3010 Grand Ave
Waukegan, IL 60085-2321

Mailing address

3010 Grand Ave
Waukegan, IL 60085-2321
Phone (847) 377-8180

Other identifiers 2

IdentifierTypeStateIssuer
125055453OtherILSTATE LICENSE
036.127489OtherILSTATE LICENSE

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
I20120220000917 IL Practitioner - Family Practice 7911165154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

Practice addresses (Care Compare)

9809 39TH Ave
Suite 2
Pleasant Prairie, WI 53158-3733
Phone (262) 925-5080

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.127489ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NPI 1164446712 CurrentSince Nov 5, 2011 Accepting new patients
County of Lake Current Accepting new patients
County of Lake CurrentSince Nov 5, 2011 Accepting new patients
County of Lake Past Accepting new patients

Locations

800 High School Dr
Round Lake, IL 60073
Phone (847) 270-9300

224 W Clarendon Dr
Round Lake Beach, IL 60073
Phone (847) 377-8800

2400 Belvidere Rd
Waukegan, IL 60085
Phone (847) 377-8400

3010 Grand Ave
Waukegan, IL 60085
Phone (847) 377-8296

1911 27th St
Zion, IL 60099
Phone (847) 377-8800

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.

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354320000000",
    "number": "1831352038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKKAR",
        "first_name": "LUMA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2012-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.127489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "125055453",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036.127489",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.