Jesse Brown VA Medical Center

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

JESSE BROWN VA MEDICAL CENTER

Practice address

820 S Damen
Chicago, IL 60612

Phone

(312) 569-6397

NPI assigned

Jun 9, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Subhadra S Vundavilli, PT

Title

Physical Therapist

Phone

(312) 569-6397

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083655336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476 ALLES ST",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600167871",
            "telephone_number": "708-539-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S DAMEN",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-569-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSE BROWN VA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VUNDAVILLI",
        "authorized_official_first_name": "SUBHADRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "312-569-6397",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI ENUMERATOR NUMBER",
            "identifier": "161639",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jess London Shields PLLC
• Anna E Jess, DPT
• Jesse Brown VA
• Jesse Brown VA
• Jesse Brown VA Medical Center
• Jesse Brown VA Medical Center
• Jesse Brown VA Medical Center
• Jesse Brown VA Medical Center
• Jesse Brown VA Medical Center
• Jesse Brown VA Medical Center

• Physical Therapy Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.