Individual provider Active NPI

Susan Pearlson, M.D.

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1972641934
Registry record updated Jan 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036-107647 Issued in IL
Practice address
645 N Michigan Ave
Unit B
Chicago, IL 60611-2826
Phone
(773) 531-3427
NPI assigned
Feb 2, 2007
Last updated
Jan 15, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychiatry Physician 2084F0202X 036-107647 IL
Psychiatry Physician 2084P0800X 036-107647 IL Primary
Psychosomatic Medicine Physician 2084P0015X 036-107647 IL

Addresses

Primary practice location

645 N Michigan Ave
Unit B
Chicago, IL 60611-2826

Mailing address

645 N Michigan Ave
Unit B
Chicago, IL 60611-2826
Phone (773) 531-3427

Other identifiers 1

IdentifierTypeStateIssuer
IL3372001OtherILMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-107647ILMDForensic Psychiatry Physician

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389744000000",
    "number": "1972641934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 N MICHIGAN AVE",
            "address_2": "UNIT B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112826",
            "telephone_number": "773-531-3427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 N MICHIGAN AVE",
            "address_2": "UNIT B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112826",
            "telephone_number": "773-531-3427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARLSON",
        "first_name": "SUSAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2014-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "IL",
            "license": "036-107647",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-107647",
            "primary": true
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "IL",
            "license": "036-107647",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IL3372001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.