Samantha Claire Gordon, MD

Primary specialty

Pediatric Dermatology PhysicianTaxonomy code 207NP0225X

License

036151568 Issued in IL

Practice address

1765 N Elston Ave Ste 110
Chicago, IL 60642-1501

Phone

(773) 276-1100

Fax

(773) 276-1102

NPI assigned

Jun 7, 2016

Last updated

Aug 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Dermatology

Education

Loyola University of Chicago, Stritch School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalskin Medical Group Il PLLCGroup PAC ID 5991116261, 56 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Mattoon, IL
  • NPI 1063030252
  Medicare reassignment Care Compare group NPD
• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Chicago, IL
  • NPI 1417657321
  NPD

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1871942177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 N ELSTON AVE STE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606421501",
            "telephone_number": "773-276-1100",
            "fax_number": "773-276-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 N ELSTON AVE STE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606421501",
            "telephone_number": "773-276-1100",
            "fax_number": "773-276-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SAMANTHA",
        "middle_name": "CLAIRE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-07",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36151568",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "IL",
            "license": "036151568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Gordon
• Lori Michelle Gordon
• Margaret Gordon, NP
• Mikalei Yelena Gordon, MD
• Nancy Gordon, LCSW
• Sara C Gordon, DDS
• Shannon Gordon, MD
• Shelby Gordon
• Silvana Gordon, PT, DPT
• Stephen Jerome Gordon, DDS

• Pediatric Dermatology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.