Individual provider Active NPI

Samantha R. Charles, DNP-C

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1982202206
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209021761 Issued in IL
Practice address
675 N Saint Clair St Ste 21-100
Chicago, IL 60611-5970
Phone
(312) 695-0990
Fax
(312) 472-5270
NPI assigned
Oct 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209021761 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 21-100
Chicago, IL 60611-5970

Mailing address

675 N Saint Clair St Ste 21-100
Chicago, IL 60611-5970
Phone (312) 695-0990

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210211000990 IL Practitioner - Nurse Practitioner 6608281373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

251 E Huron
Chicago, IL 60611-2908

251 E Huron St
Chicago, IL 60611-2908

4445 W Irving Park Rd
Chicago, IL 60641-2808

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Dec 5, 2022 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Dec 5, 2022 Accepting new patients
Ctca Physicians Group of Illinois, Inc Past Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

675 N Saint Clair St
Ste 21100
Chicago, IL 60611

675 N Saint Clair St
Ste 21-100
Chicago, IL 60611
Phone (312) 908-5284

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Interoperability endpoints

  • Direct secure messaging: samantha.charles.p1@direct.ctca-clinic.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1602201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1982202206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 21-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115970",
            "telephone_number": "312-695-0990",
            "fax_number": "312-472-5270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 21-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115970",
            "telephone_number": "312-695-0990",
            "fax_number": "312-472-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "SAMANTHA",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "DNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-09",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209021761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.