NPIMap

Organization Active NPI

Thoracic Surgical Associates, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Chicago Ridge, IL
National Provider Identifier
1225528979
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
PENDING Issued in IL
Legal business name
THORACIC SURGICAL ASSOCIATES, LLC
Practice address
10604 Southwest Highway
Suite 101
Chicago Ridge, IL 60415
Phone
(708) 346-4065
Fax
(708) 423-5799
NPI assigned
May 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
Dr. Paul Gordon, MDNPI 1356341994
Title
President
Phone
(708) 346-4065

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
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X PENDING IL Primary

Addresses

Primary practice location

10604 Southwest Highway
Suite 101
Chicago Ridge, IL 60415

Mailing address

10604 Southwest Highway
Suite 101
Chicago Ridge, IL 60415
Phone (708) 346-4065

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGOtherILIL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180921002597 IL Part B Supplier - Clinic/Group Practice 7315298809 Receives reassigned benefits from 3 practitioners
Practice locations: Chicago Ridge, IL

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.317510

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1225528979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 SOUTHWEST HIGHWAY",
            "address_2": "SUITE 101",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "60415",
            "telephone_number": "708-346-4065",
            "fax_number": "708-423-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10604 SOUTHWEST HIGHWAY",
            "address_2": "SUITE 101",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "60415",
            "telephone_number": "708-346-4065",
            "fax_number": "708-423-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THORACIC SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-346-4065",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE",
            "identifier": "PENDING",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.