Vicki R Samuels, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036101746 Issued in IL

Practice address

10 S Riverside PLZ Ste 2225
Chicago, IL 60606-3707

Phone

(312) 273-4930

Fax

(312) 628-5100

NPI assigned

Jan 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Sep 12, 2018 through Sep 12, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: vicki.samuels@14761201434628.direct.elationemr.com

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1922087725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 S RIVERSIDE PLZ STE 2225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606063707",
            "telephone_number": "312-273-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S RIVERSIDE PLZ STE 2225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606063707",
            "telephone_number": "312-273-4930",
            "fax_number": "312-628-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "VICKI",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-11",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036101746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036101746",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriella Grace Samuels, LCPC
• Jeffrey Samuels
• Joseph Bradley Samuels, PA-C
• Kayla Nichole Samuels
• Kerby Ashley Samuels, M.D.
• Isaac William Samuelson, LPC
• Jane Ellen Samuelson, PH. D.
• Lanay L Samuelson, ANP
• Lisa Samuelson
• Jadwiga Samulak, DDS

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.