Ortho Spine Surgical LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ORTHO SPINE SURGICAL LLC

Practice address

1925 E 95TH St Ste 220
Chicago, IL 60617-4710

Phone

(773) 761-0500

Fax

(773) 761-1355

NPI assigned

Sep 8, 2020

Last updated

Sep 8, 2020By 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

Mr. Mohamed S Sirajudeen

Title

President

Phone

(773) 761-0500

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1386258226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 E 95TH ST STE 220",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174710",
            "telephone_number": "773-761-0500",
            "fax_number": "773-761-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E 95TH ST STE 220",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174710",
            "telephone_number": "773-761-0500",
            "fax_number": "773-761-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO SPINE SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "SIRAJUDEEN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-761-0500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.sisfirst.com/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1925 E 95th St Ste 220",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606174710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.