NPIMap

Rajiv Kandala M D S C

Organization Active NPI Family Medicine Physician · Chicago, IL

NPI 1114094281 · NPPES record last updated Mar 7, 2023

Key facts

NPI
1114094281
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
RAJIV KANDALA M D S C
Practice address
7531 S Stony Island
#152
Chicago, IL 60649
Phone
(773) 947-2831
NPI assigned
Nov 30, 2006
Organization subpart
No

Authorized official

Name
Dr. Rajiv Kandala NPI 1376608059
Title
Secretary
Phone
(773) 793-4527

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1052767Rajiv Kandala
7531 S Stony Island Ave, Suite 164, Chicago, IL 60649		Certificate of waiverApr 3, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040317001451 IL Part B Supplier - Clinic/Group Practice 0345130977 Receives reassigned benefits from 19 practitioners
Practice locations: Chicago, IL

National Provider Directory

Locations

7531 S Stony Island Ave
#152
Chicago, IL 60649
Phone (773) 947-2831

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

7531 S Stony Island
#152
Chicago, IL 60649

Mailing address

1720 S Michigan Ave Apt 2909
Chicago, IL 60616-4861
Phone (630) 405-5500

Other identifiers

IdentifierTypeStateIssuer
036109208MedicaidIL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2023.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1114094281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 S MICHIGAN AVE APT 2909",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164861",
            "telephone_number": "630-405-5500",
            "fax_number": "708-226-5690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7531 S STONY ISLAND",
            "address_2": "#152",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60649",
            "telephone_number": "773-947-2831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAJIV KANDALA M D S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2023-03-07",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "KANDALA",
        "authorized_official_first_name": "RAJIV",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "773-793-4527",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036109208",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

All providers in Chicago, IL · Family Medicine Physician in Illinois

Sources for this page

Verify at the official NPI Registry.