NPIMap

Individual provider Active NPI

Sudarsana Chakrabarti, MD

  • Cardiovascular Disease Physician
  • Homer Glen, IL
National Provider Identifier
1104096940
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036119041 Issued in IL
Practice address
15750 S Bell Rd
2D
Homer Glen, IL 60491-8412
Phone
(708) 737-7136
Fax
(708) 887-5886
NPI assigned
Mar 7, 2008
Last updated
Apr 6, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036119041 IL Primary

Addresses

Primary practice location

15750 S Bell Rd
2D
Homer Glen, IL 60491-8412

Mailing address

113 Circle Ridge Dr
Burr Ridge, IL 60527-8380
Phone (708) 737-7136

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
I20090203000572 IL Practitioner - Internal Medicine 5991869190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

15750 S Bell Rd
Suite 2D
Homer Glen, IL 60491-8420
Phone (708) 737-7136

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue404
Removal of skin lesions24

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Suburban Wellness SC CurrentSince Nov 1, 2013 Accepting new patients

Locations

15750 S Bell Rd
Ste 2D
Homer Glen, IL 60491
Phone (630) 460-2136

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1204848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491436800000",
    "number": "1104096940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 CIRCLE RIDGE DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605278380",
            "telephone_number": "708-737-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15750 S BELL RD",
            "address_2": "2D",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604918412",
            "telephone_number": "708-737-7136",
            "fax_number": "708-887-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAKRABARTI",
        "first_name": "SUDARSANA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-07",
        "last_updated": "2017-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036119041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer Glen, IL

Sources for this page

Verify at the official NPI Registry.