NPIMap

Individual provider Active NPI

Samer Rodwan Rajjoub, M.D.

  • Surgery Physician
  • Palos Heights, IL
National Provider Identifier
1891920120
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036.098470 Issued in IL
Practice address
12251 S 80TH Ave
St. George Ambulatory Center
Palos Heights, IL 60463-1256
Phone
(708) 923-4400
Fax
(708) 923-4421
NPI assigned
May 15, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036.098470 IL Primary

Addresses

Primary practice location

12251 S 80TH Ave
St. George Ambulatory Center
Palos Heights, IL 60463-1256

Mailing address

12251 S 80TH Ave Ste 204
Palos Heights, IL 60463-1290
Phone (708) 923-4400

Other practice location 1

806 E Walnut St
Watseka, IL 60970-1583
Phone (815) 432-1078

Other identifiers 1

IdentifierTypeStateIssuer
036137162MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160818002317 IL Practitioner - General SurgeryPractitioner - Other (Physician) 2567694664 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
George Washington University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians
Gibson Community Hospital AssociationGroup PAC ID 5092703124, 159 clinicians

Practice addresses (Care Compare)

12251 S 80TH Ave
Palos Heights, IL 60463-1290
Phone (708) 923-5869

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

806 E Walnut St
Suite a
Watseka, IL 60970-1584
Phone (815) 432-1078

Hospital & facility affiliations

  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Gibson Community Hospital Hospital, Gibson City, IL, CCN 141317
  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Colonoscopy1-10
Hernia repair (minimally invasive)23
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.098470ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Sep 1, 2021 Accepting new patients
Insight Chicago, Inc. Surgery CurrentSince Dec 1, 2022 Accepting new patients
Great Lakes Endocrine and General Surgery LLC Surgery Current Accepting new patients
Insight Chicago, Inc. CurrentSince Dec 1, 2022 Accepting new patients
Gibson Community Hospital Association CurrentSince Nov 1, 2023 Accepting new patients
Central Dupage Physician Group CurrentSince Sep 1, 2021 Accepting new patients
Gibson Community Hospital Association CurrentSince Nov 1, 2023 Accepting new patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

2525 S Michigan Ave
Chicago, IL 60616
Phone (312) 355-1153

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

15300 West Ave
Orland Park, IL 60462
Phone (708) 226-2440

12251 S 80th Ave
Ste 204
Palos Heights, IL 60463
Phone (708) 923-3388

12251 S 80th Ave
Palos Heights, IL 60463
Phone (708) 361-4500

12255 S 80th Ave
Ste 204
Palos Heights, IL 60463
Phone (708) 923-4400

12251 S 80th Ave
Ofc
Palos Heights, IL 60463

1400 W Park St
Urbana, IL 61801
Phone (217) 337-2000

806 E Walnut St
Ste A
Watseka, IL 60970
Phone (815) 432-1078

806 E Walnut St
Watseka, IL 60970
Phone (815) 432-1078

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Interoperability endpoints

  • Direct secure messaging: samer.rajjoub.p44@direct.gapho.nextgenshare.com

Organizations & group practices 9

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 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1891920120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE STE 204",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-4400",
            "fax_number": "708-923-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE",
            "address_2": "ST. GEORGE AMBULATORY CENTER",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631256",
            "telephone_number": "708-923-4400",
            "fax_number": "708-923-4421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "806 E Walnut St",
            "address_purpose": "LOCATION",
            "city": "Watseka",
            "state": "IL",
            "postal_code": "609701583",
            "country_code": "US",
            "telephone_number": "815-432-1078",
            "fax_number": "815-432-1079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAJJOUB",
        "first_name": "SAMER",
        "middle_name": "RODWAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-15",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.098470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036137162",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.