Suburban Pediatrics Medical Center, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036124598 Issued in IL

Legal business name

SUBURBAN PEDIATRICS MEDICAL CENTER, LLC

Doing business as

Dr. Carletha Hughes

Practice address

165 W 10TH St
Chicago Heights, IL 60411-2000

Phone

(708) 754-3507

Fax

(708) 754-6153

NPI assigned

Jul 31, 2017

Last updated

Jul 31, 2017By 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. Carletha Carol Hughes, MDNPI 1023249075

Title

Owner

Phone

(708) 754-3507

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Carletha Hughes Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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.

• Carletha Carol Hughes, MD

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1023249075
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1346764438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3037 CARMEL DR",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604222263",
            "telephone_number": "773-983-3948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 W 10TH ST",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112000",
            "telephone_number": "708-754-3507",
            "fax_number": "708-754-6153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN PEDIATRICS MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "CARLETHA",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-754-3507",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036124598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023249075",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Carletha Hughes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nelly Staines, OTR/L
• Walter B Stanford, D.D.S.
• Tyra Storey, AGPCNP
• David James Storm, D.D.S.
• Suburban Health and Rehabilitation Center
• Darrin Sutton
• Lidiane Fumiko Takeda, DDS
• Lindsey Tamulonis
• Tiffany HN Tang, OD
• Jason J Tanguay, D.O.

• Pediatrics Physician in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; 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.