Individual provider Active NPI

Suwon Vickie Nopachai, M.D.

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1104054063
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
125057164 Issued in IL
Practice address
1645 W Jackson Blvd
Suite 215
Chicago, IL 60612-3276
Phone
(312) 942-8000
NPI assigned
Jun 30, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125057164 IL
Pediatrics Physician 208000000X 125057164 IL Primary

Addresses

Primary practice location

1645 W Jackson Blvd
Suite 215
Chicago, IL 60612-3276

Mailing address

1645 W Jackson Blvd
Suite 215
Chicago, IL 60612-3276
Phone (312) 942-8000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130819000566 IL Practitioner - Internal MedicinePractitioner - Pediatric Medicine 2860634060 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians
Rush Oak Park Physicians Group Elmwood ParkGroup PAC ID 9234393117, 6 clinicians

Practice addresses (Care Compare)

1645 W Jackson Blvd
Chicago, IL 60612-3227

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

Hospital & facility affiliations

  • Rush University Medical Center Hospital, Chicago, IL, CCN 140119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125057164ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Center Internal Medicine CurrentSince Nov 1, 2020 Accepting new patients
Rush University Medical Group Internal Medicine CurrentSince Nov 1, 2020 Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1645 W Jackson Blvd
Ste 215
Chicago, IL 60612
Phone (312) 942-3254

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1700 W Van Buren St
Ste 500
Chicago, IL 60612
Phone (312) 563-2875

Interoperability endpoints

  • Direct secure messaging: snopachai13334@direct.rush.rush-health.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 2

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": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381190400000",
    "number": "1104054063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD",
            "address_2": "SUITE 215",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123276",
            "telephone_number": "312-942-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD",
            "address_2": "SUITE 215",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123276",
            "telephone_number": "312-942-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOPACHAI",
        "first_name": "SUWON",
        "middle_name": "VICKIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-30",
        "last_updated": "2013-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125057164",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125057164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.