Suburban Medical Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SUBURBAN MEDICAL CLINIC LLC

Practice address

1802 Irving Park Rd
Hanover Park, IL 60133-3254

Phone

(630) 289-0440

Fax

(630) 289-0442

NPI assigned

Nov 8, 2010

Organization subpart

No

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

Authorized official

Name

Anand M Thakkar, MDNPI 1336190040

Title

Owner

Phone

(630) 289-0440

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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

• Anand M Thakkar, M.D.

  • Internal Medicine Physician
  • Hanover Park, IL
  • NPI 1336190040
  Medicare reassignment NPD Authorized official
• Ritesh Patel, M.D.

  • Internal Medicine Physician
  • Schaumburg, IL
  • NPI 1548371982
  NPD (past)

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1386945319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 IRVING PARK RD",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601333254",
            "telephone_number": "630-289-0440",
            "fax_number": "630-289-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 IRVING PARK RD",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601333254",
            "telephone_number": "630-289-0440",
            "fax_number": "630-289-0442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 Tanglewood Ave",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Hanover Park",
            "state": "IL",
            "postal_code": "601333381",
            "country_code": "US",
            "telephone_number": "630-289-0440",
            "fax_number": "630-289-0442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUBURBAN MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "THAKKAR",
        "authorized_official_first_name": "ANAND",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-289-0440",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112261",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Hanover Park, IL
• Providers in Hanover Park, 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 Mar 17, 2018; 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.