NPIMap

Organization Active NPI

Rajiv Kandala M D S C

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1114094281
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

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

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1052767Rajiv Kandala7531 S Stony Island Ave, Suite 164, Chicago, IL 60649Certificate of waiverApr 3, 2028

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.