NPIMap

Individual provider Active NPI

Thirumazhisai Gunasekaran

  • Pediatric Gastroenterology Physician
  • Park Ridge, IL
National Provider Identifier
1083651749
Registry record updated May 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
036084748 Issued in IL
Practice address
1675 Dempster St
3Rd Floor
Park Ridge, IL 60068-1110
Phone
(847) 723-7700
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 036084748 IL Primary

Addresses

Primary practice location

1675 Dempster St
3Rd Floor
Park Ridge, IL 60068-1110

Mailing address

1675 Dempster St
3Rd Floor
Park Ridge, IL 60068-1110

Other identifiers 1

IdentifierTypeStateIssuer
036084748MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tgunasekaran12128@direct.luhs.org Direct LOYOLA UNIVERSITY MEDICAL CENTER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050822000962 IL Practitioner - GastroenterologyPractitioner - Pediatric Medicine 7810956323 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Pediatric Gastroenterology CurrentSince Jul 1, 2009 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jul 1, 2009 Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Condell Medical Center Past Accepting new patients
The University of Chicago Medical Centers Past Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients
Loyola University Physician Foundation Past Accepting new patients
Adventist Midwest Health Past Accepting new patients
St Alexius Medical Center Past Accepting new patients
Gottlieb Memorial Hospital Past Accepting new patients
Rush University Medical Center Past Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients

Locations

1653 W Congress Pkwy
#622
Chicago, IL 60612
Phone (312) 942-5068

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

840 S Wood St
#856
Chicago, IL 60612
Phone (312) 413-1429

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1083651749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 DEMPSTER ST",
            "address_2": "3RD FLOOR",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 DEMPSTER ST",
            "address_2": "3RD FLOOR",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681110",
            "telephone_number": "847-723-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNASEKARAN",
        "first_name": "THIRUMAZHISAI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IL",
            "license": "036084748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036084748",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tgunasekaran12128@direct.luhs.org",
            "affiliation": "Y",
            "affiliationName": "LOYOLA UNIVERSITY MEDICAL CENTER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S 1st Ave",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.