Bansa Medical Associates Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036053245 Issued in IL

Legal business name

BANSA MEDICAL ASSOCIATES INC

Practice address

1609 Sibley Blvd
Calumet City, IL 60409-2217

Phone

(708) 933-0872

NPI assigned

Aug 4, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Emmanuel Bansa, M.D.

Title

Owner

Phone

(708) 933-0872

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1501804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1326563966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 SIBLEY BLVD",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604092217",
            "telephone_number": "708-933-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 SIBLEY BLVD",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604092217",
            "telephone_number": "708-933-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANSA MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BANSA",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-933-0872",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036053245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036053245",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Calumet City, IL
• Providers in Calumet City, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.