Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1992704332 Deactivated / Inactive NPI Male Practitioner

Dr. Samir A Patel , DO

Pediatrics • Decatur, IL

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Samir Patel has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 19, 2005
NPI Deactivation Date March 18, 2006
Total Practice Duration ~1 Years of Practice (2005 – 2006)

Professional Overview & Biography Verified Profile Summary

Dr. Samir Patel, DO was a registered Pediatrics practicing in Decatur, IL. Throughout an active medical career spanning 1 years, Dr. Patel provided care at the practice location at 1730 E LAKE SHORE DR until profile deactivation on 2006-03-18.

Practice Location & Contact Primary Location

Practice Address

1730 E Lake Shore Dr

Decatur, IL 625213809

Telephone 2173291000
Fax 2173291055
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Decatur, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 30.0 Yrs
State Avg: 21.7 Yrs
Regional Practice Density
15 Specialists

Practicing in Decatur, IL (3277 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2021-12-30
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License IL 036096741

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
036094812 (IL)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners
NPI 1033214994

Doctor of Medicine (M.D.)

Dr. Jignesh Modi , MD

Internal Medicine - Infectious Disease

NPI 1184935074

Doctor of Medicine (M.D.)

Dr. Manoj Kohli , MD

Internal Medicine - Rheumatology

NPI 1215948146

Doctor of Medicine (M.D.)

NPI 1255452124

Doctor of Osteopathic Medicine (D.O.)

Emily Artime , PA

Physician Assistant

NPI 1255560629

Physician Assistant

NPI 1255696605

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location December 30, 2021

Registered at 1730 E LAKE SHORE DR, DECATUR, IL 625213809 (Tel: 2173291000)

📍
Updated Practice Location March 10, 2011

Registered at 1900 E LAKE SHORE DR, SUITE 330, DECATUR, IL 625213824 (Tel: 2174232889)

📍
Updated Business Mailing Address March 10, 2011

Registered at 1900 E LAKE SHORE DR, SUITE 330, DECATUR, IL 625213824 (Tel: 2174232889)

👤
Provider Name / Credentials Updated March 10, 2011

Recorded as SAMIR PATEL, D.O.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 10, 2011

Pediatrics (License #036096741 in IL)

🔄
NPI Profile Reactivated March 27, 2006

Record officially reactivated for active practice on March 27, 2006

⚠️
NPI Profile Deactivated March 18, 2006

Record deactivated on March 18, 2006

🟢
Initial NPI Registration & Enumeration July 19, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Samir Patel. Be the first to share your experience!

Sign in to leave a review for Dr. Samir Patel

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1992704332
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 19, 2005
Last Update: December 30, 2021
Deactivation Date: March 18, 2006
Sole Proprietor: Yes

Mailing Address

1900 E Lake Shore Dr, Suite 330

Decatur, IL 625213824

Phone: 2174232889

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.