Susanna Antonia McColley, MD

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

License

36089384 Issued in IL

Practice address

2300 Childrens Plaza
#43
Chgo, IL 60614

Phone

(773) 880-8104

Fax

(773) 880-6300

NPI assigned

Mar 10, 2006

Last updated

Sep 21, 2011By 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 1

Addresses

Other identifiers 1

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

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.

• Lurie Children's Medical Group Inc

  dba LCMG Inc

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1518064716
  Medicare reassignment NPD
• Lurie Children's Medical Group, LLC

  dba LCMG

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1992758544
  NPD (past)

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1962470336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 WEST MONTANA",
            "city": "CHGO",
            "state": "IL",
            "postal_code": "606142220",
            "telephone_number": "773-348-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 CHILDRENS PLAZA",
            "address_2": "#43",
            "city": "CHGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "773-880-8104",
            "fax_number": "773-880-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLEY",
        "first_name": "SUSANNA",
        "middle_name": "ANTONIA",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "IL",
            "license": "36089384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036089384",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie Dipasquale
• Carolyn Jean Fields, LCSW
• Sara M Gotheridge, M.D.
• Michael J. King
• Chin Man Kung, MD
• Kimberly McMahon, M.D.
• Dayna Salasche, M.D.
• Seema Venkatachalam, M.D.
• Giselle Tisha Wallace, CNA
• Bonnie E. Wise, M.D.

• Pediatric Pulmonology Physician in Chgo, IL
• Providers in Chgo, IL by specialty
• Pediatric Pulmonology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.