Cermak Children'S Clinic, S.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036105483 Issued in IL

Legal business name

CERMAK CHILDREN'S CLINIC, S.C.

Practice address

6917 W Cermak Road
Berwyn, IL 60804-2172

Phone

(708) 788-4933

Fax

(708) 788-5296

NPI assigned

Oct 2, 2012

Organization subpart

No

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

Authorized official

Name

Dr. George Thomas Ampalloor, M.D.NPI 1194733584

Title

President

Phone

(847) 840-9714

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• George Thomas Ampalloor, MD

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1194733584

  Pediatrics

  NPD (past) Authorized official

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1306198247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "STE - 402",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222789",
            "telephone_number": "773-292-4501",
            "fax_number": "773-292-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6917 W CERMAK ROAD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "608042172",
            "telephone_number": "708-788-4933",
            "fax_number": "708-788-5296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERMAK CHILDREN'S CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "AMPALLOOR",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-840-9714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036105483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105483",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valeria Castro, O.D.
• Joanna Ceballos
• Central Foundations
• Cepamerica Illinois LLP
• Anthony Cerda
• Cermak Optical, Inc
• Bianca Cervantes, LCPC
• Hilda Cervantes
• Ron J Chacko, MD
• Pablo E Chagoya, M.D.

• All providers in Berwyn, IL
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.