Individual provider Active NPI

Soujanya Reddy Tummuru, D.O

  • Obstetrics & Gynecology Physician
  • Park Ridge, IL
National Provider Identifier
1407029663
Registry record updated Mar 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036130282 Issued in IL
Practice address
1875 Dempster St
Suite 245
Park Ridge, IL 60068-1186
Phone
(847) 692-9234
NPI assigned
Apr 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036130282 IL Primary

Addresses

Primary practice location

1875 Dempster St
Suite 245
Park Ridge, IL 60068-1186

Mailing address

1875 Dempster St
Suite 245
Park Ridge, IL 60068-1186
Phone (847) 692-9234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140114001467 IL Practitioner - Obstetrics/Gynecology 1254569403 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Center for Women'S Healthcare, LTDGroup PAC ID 7012818354, 93 clinicians

Practice addresses (Care Compare)

1875 Dempster St
Suite 245
Park Ridge, IL 60068-1126
Phone (847) 692-9234

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Advocate Lutheran General Hospital Hospital, Park Ridge, IL, CCN 140223
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036130282ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Center for Women'S Health Care, LTD. Obstetrics & Gynecology CurrentSince Dec 11, 2024 Accepting new patients

Locations

2801 Lakeside Dr
Ste 209
Bannockburn, IL 60015
Phone (847) 562-1410

21660 W Field Pkwy
Fl 3
Deer Park, IL 60010
Phone (847) 692-9234

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

1875 Dempster St
Ste 245
Park Ridge, IL 60068
Phone (847) 692-9234

2604 Dempster St
Park Ridge, IL 60068
Phone (847) 219-9600

350 S Northwest Hwy
Ste 112
Park Ridge, IL 60068
Phone (847) 825-8108

2604 W Dempster St
Ste 410
Park Ridge, IL 60068
Phone (847) 692-9234

18931 W Washington St
Ste 100
Third Lake, IL 60030
Phone (847) 548-2200

Interoperability endpoints

  • Direct secure messaging: stummuru@whs.gwaydirect.com
  • Direct secure messaging: soujanya.tummuru.1@21117.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488326400000",
    "number": "1407029663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 245",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-692-9234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 245",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-692-9234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUMMURU",
        "first_name": "SOUJANYA",
        "middle_name": "REDDY",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2017-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036130282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.