DR. MATTHEW I SAMUELSON (NPI# 1568534147) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568534147 |
| Entity Type | Individual |
| Full Name | DR. MATTHEW I SAMUELSON |
| Credential | M.D. |
| Practice Address |
420 N Il Route 31 Crystal Lake IL 60012-3711 |
| Practice Telephone | 8153565200 |
| Practice Fax Number | 8153565262 |
| Mailing Telephone | 8153565200 |
| Mailing Fax Number | 8153565262 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2017-08-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 036086139 | IL | Allopathic & Osteopathic Physicians |
| Y | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
036-086139 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036086139 | 05 |
| Street Address |
420 N IL ROUTE 31 |
| City | CRYSTAL LAKE |
| State | IL |
| Zip Code | 60012-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467485128 | Gordon D Husby | Physical Therapist | 420 N Il Route 31, Crystal Lake, IL 60012-3711 | 2006-07-08 |
| 1134648389 | Ryan Miguel Colon | Physician Assistant | 420 N Il Route 31, Crystal Lake, IL 60012 | 2017-09-19 |
| 1497295125 | Alexander J Hembrey | Physician Assistant | 420 N Il Route 31, Crystal Lake, IL 60012 | 2017-02-28 |
| 1316486459 | Nicole M Trittschuh | Physician Assistant | 420 N Il Route 31, Crystal Lake, IL 60012 | 2017-02-22 |
| 1356883599 | Centegra Primary Care LLC | Family Medicine | 420 N Il Route 31, Crystal Lake, IL 60012-3709 | 2016-11-04 |
| 1770954125 | Lisa Zemaitis | Physical Therapy Assistant | 420 N Il Route 31, Crystal Lake, IL 60012-3709 | 2015-10-12 |
| 1336552199 | Nicole Ashley Fox | Physical Therapist | 420 N Il Route 31, Crystal Lake, IL 60012-3711 | 2014-06-09 |
| 1497168355 | Heather Michelle Murnane | Occupational Therapist | 420 N Il Route 31, Crystal Lake, IL 60012-3711 | 2014-06-09 |
| 1528487436 | Michael Christopher Ciccotti | Orthopaedic Surgery | 420 N Il Route 31, Crystal Lake, IL 60012-3709 | 2014-04-08 |
| 1326483280 | Mark Andrew Rotert | Nurse Practitioner | 420 N Il Route 31, Crystal Lake, IL 60012 | 2013-05-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033574629 | Joan M Ryan | Counselor | 610 N Route 31, Suite E, Crystal Lake, IL 60012 | 2015-12-23 |
| 1285972331 | Lauren Elyse Westerman | Physical Therapist | 1000 Brighton Ln, Crystal Lake, IL 60012 | 2013-01-24 |
| 1447537469 | Sean Gale | Pharmacist | 135 Carmella Dr, Crystal Lake, IL 60012 | 2011-11-04 |
| 1477836625 | Judy Meekyung Fakhouri | Pharmacist | 315 N. Route 31, Crystal Lake, IL 60012 | 2011-09-23 |
| 1730462136 | Leslie Dawn Weckerlin | Pharmacist | 315 N Route 31, Crystal Lake, IL 60012 | 2011-09-21 |
| 1639452188 | Laura Jean Galles | Pharmacist | 315 N. Routet 31, Crystal Lake, IL 60012 | 2011-09-21 |
| 1326320516 | Stacey Jean Knuth | Pharmacist | 315 North Route 31, Crystal Lake, IL 60012 | 2011-09-13 |
| 1356469803 | Donn Orien Humphries | Chiropractor | 690 N Route 31, Suite F, Crystal Lake, IL 60012 | 2007-03-26 |
| 1538204508 | Midwest Physical Therapy Ctr | Clinic/Center | 630 N Rt 31, Suite 103, Crystal Lake, IL 60012 | 2007-02-20 |
| 1356488415 | Charlotte Joy Parcels | Social Worker | 8600 Route 14, Suite 110, Crystal Lake, IL 60012 | 2007-01-30 |
| Find all providers in zip 60012 | ||||
| Taxonomy Code | 207XX0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Foot and Ankle Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: title modified, definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. ACGME Accredited Residency Program Requirements: 1 year of training with 5 years Orthopedic Surgery for a total of 6 years. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588189419 | Oa Associates LLC | Orthopaedic Surgery | 200 Admiral Trost Rd, Columbia, IL 62236-2163 | 2017-08-11 |
| 1275829954 | Raymond R Montoya II | Orthopaedic Surgery | 259 E Erie St Ste 2230, Chicago, IL 60611-3370 | 2011-06-21 |
| 1497231518 | Saluja Kaushali Mahabamunuge | Orthopaedic Surgery | 2160 S 1st Ave, Maywood, IL 60153 | 2018-07-11 |
| 1528563483 | Christopher Cklamovski | Orthopaedic Surgery | 2160 S 1st Ave, Maywood, IL 60153 | 2018-03-24 |
| 1427505197 | Kelly Hynes | Orthopaedic Surgery | 5841 S Maryland Ave, Mc3079, Room P211m, Chicago, IL 60637-1447 | 2016-09-09 |
| 1417339995 | Kurt Krautmann | Orthopaedic Surgery | 251 E Huron St, Chicago, IL 60611-2908 | 2015-06-22 |
| 1972919702 | Jonathan L Hook | Orthopaedic Surgery | 2850 S Wabash Ave Ste 100, Chicago, IL 60616 | 2014-07-01 |
| 1659716751 | Gina Rose Cahill | Orthopaedic Surgery | 929 W Higgins Rd, Schaumburg, IL 60195-3203 | 2013-05-02 |
| 1801181920 | Shaun Kink | Orthopaedic Surgery | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2011-06-16 |
| 1841501962 | Bryant Shane Ho | Orthopaedic Surgery | 550 W Ogden Ave, Hinsdale, IL 60521-3186 | 2010-06-23 |
| Find all providers with the same taxonomy | ||||
| City | CRYSTAL LAKE |
| Zip Code | 60012 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.