NPIMap

Individual provider Active NPI

Samuel J Traverso, DO

  • Family Medicine Physician
  • La Grange Highlands, IL
National Provider Identifier
1902464647
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036160173 Issued in IL
Practice address
5201 Willow Springs Rd Ste 300
La Grange Highlands, IL 60525-6539
Phone
(708) 482-8088
Fax
(708) 482-9034
NPI assigned
May 29, 2019
Last updated
Oct 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

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 036160173 IL Primary

Addresses

Primary practice location

5201 Willow Springs Rd Ste 300
La Grange Highlands, IL 60525-6539

Mailing address

5201 Willow Springs Rd Ste 300
La Grange Highlands, IL 60525-6539
Phone (708) 482-8088

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
I20230210000201 IL Practitioner - Family Practice 4587091343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Medical Center of Lagrange LTDGroup PAC ID 0749243939, 3 clinicians

Practice addresses (Care Compare)

5201 Willow Springs Rd
Suite 300
La Grange Highlands, IL 60525-6539
Phone (708) 482-8088

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036160173ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Center of Lagrange LTD Family Medicine CurrentSince Oct 12, 2022 Accepting new patients

Locations

5201 Willow Springs Rd
Ste 300
La Grange Highlands, IL 60525
Phone (708) 482-8088

Organizations & group practices 1

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.

Hospital & facility affiliations 10

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": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1902464647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 WILLOW SPRINGS RD STE 300",
            "city": "LA GRANGE HIGHLANDS",
            "state": "IL",
            "postal_code": "605256539",
            "telephone_number": "708-482-8088",
            "fax_number": "708-482-9034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 WILLOW SPRINGS RD STE 300",
            "city": "LA GRANGE HIGHLANDS",
            "state": "IL",
            "postal_code": "605256539",
            "telephone_number": "708-482-8088",
            "fax_number": "708-482-9034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVERSO",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-29",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036160173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Highlands, IL

Sources for this page

Verify at the official NPI Registry.