Active NPI
Sandeep Pavuluri
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1235819186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125.082212
- Practice address
- 4646 N Marine Dr
Chicago, IL 60640-5759 - Phone
- (077) 356-4522
- NPI assigned
- Jul 24, 2023
- Last updated
- Oct 23, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125.082212 | IL | Primary |
Addresses
Primary practice location
4646 N Marine Dr
Chicago, IL 60640-5759
Mailing address
4646 N Marine Dr
Chicago, IL 60640-5759
Phone (077) 356-4522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.082212 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698019200000",
"number": "1235819186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4646 N MARINE DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405759",
"telephone_number": "077-356-4522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 N MARINE DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405759",
"telephone_number": "077-356-4522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVULURI",
"first_name": "SANDEEP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-24",
"last_updated": "2023-10-23",
"certification_date": "2023-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125.082212",
"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 Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.