NPIMap

Organization Active NPI

Southwest Medical Group LTD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1306114426
Registry record updated Dec 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036118695 Issued in IL
Legal business name
SOUTHWEST MEDICAL GROUP LTD
Practice address
4316 N Elston Ave
Chicago, IL 60641-2144
Phone
(773) 754-3728
Fax
(773) 754-3504
NPI assigned
Dec 3, 2011
Last updated
Dec 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2011

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

Authorized official

Name
Dr. Farooq M Ahmed, MDNPI 1275553240
Title
President
Phone
(773) 754-3728

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 036118695 IL Primary

Addresses

Primary practice location

4316 N Elston Ave
Chicago, IL 60641-2144

Mailing address

4316 N Elston Ave
Chicago, IL 60641-2144
Phone (773) 754-3728

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120613000579 IL Part B Supplier - Clinic/Group Practice 1153585658 Receives reassigned benefits from 10 practitioners
Practice locations: Oak Lawn, IL

National Provider Directory

National Provider Directory

Locations

4316 N Elston Ave
Chicago, IL 60641
Phone (773) 754-3728

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1322870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322870400000",
    "number": "1306114426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4316 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412144",
            "telephone_number": "773-754-3728",
            "fax_number": "773-754-3504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4316 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412144",
            "telephone_number": "773-754-3728",
            "fax_number": "773-754-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-03",
        "last_updated": "2011-12-03",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "FAROOQ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-754-3728",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036118695",
            "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 Dec 3, 2011; 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.