Samara Derdiger, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164009053 Issued in IL

Practice address

20817 N Horatio Blvd
Lincolnshire, IL 60069-9614

Phone

(847) 946-3289

NPI assigned

Jun 14, 2024

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1718323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1912740390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20817 N HORATIO BLVD",
            "city": "LINCOLNSHIRE",
            "state": "IL",
            "postal_code": "600699614",
            "telephone_number": "847-946-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20817 N HORATIO BLVD",
            "city": "LINCOLNSHIRE",
            "state": "IL",
            "postal_code": "600699614",
            "telephone_number": "847-946-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDIGER",
        "first_name": "SAMARA",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-14",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L007793",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164009053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Onetha Davis
• Lauren Michele Deets, PT, DPT
• Oana Demian, PSYD
• Amanda Devine, MAT, ATC, LAT, OTC
• Diabetes DME LLC (Diabetes DME)
• Ryl Diaz
• Dmitry D. Sokol, D.D.S., L.T.D. (Village Green Dentistry)
• Zachary Beck Domont, MD

• Registered Dietitian in Lincolnshire, IL
• Providers in Lincolnshire, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.