St Jude Medical Clinic SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ST JUDE MEDICAL CLINIC SC

Practice address

3943 W 31St St
Chicago, IL 60623-4936

Phone

(773) 523-8773

Fax

(773) 523-9259

NPI assigned

Feb 3, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Roma Shukla, DO

Title

Manager

Phone

(773) 523-8773

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Manish M Shukla, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1619983558
  Medicare reassignment NPD

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

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1326186941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3943 W 31ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234936",
            "telephone_number": "773-523-8773",
            "fax_number": "773-523-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3943 W 31ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234936",
            "telephone_number": "773-523-8773",
            "fax_number": "773-523-9259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE MEDICAL CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-03",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "SHUKLA",
        "authorized_official_first_name": "ROMA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-523-8773",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole St Jean, PSY.D.
• St John Heart Clinic SC
• Nicole S St John, MS, RDN, LDN
• St Joseph Hospital
• St Joseph Hospital
• Andrea Gabrielle St Laurent, DO
• St Margaret Mercy Healthcare Centers, Inc. (Hegewisch Health Center)
• St Mary and Elizabeth Medical Center
• St Mary's Hospital
• St Michaels Counseling Center

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.