Active NPI
Sompop Srisuwananukorn, M.D.
- Pulmonary Disease Physician
- Whiting, IN
National Provider Identifier
1467439828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 01030518
- Practice address
- 2075 Indianapolis Blvd
Whiting, IN 46394-1948 - Phone
- (219) 659-7000
- Fax
- (219) 659-9018
- NPI assigned
- Dec 28, 2005
- Last updated
- Jan 16, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 01030518 | IN | |
| Pulmonary Disease Physician | 207RP1001X | 01030518 | IN | Primary |
Addresses
Primary practice location
2075 Indianapolis Blvd
Whiting, IN 46394-1948
Mailing address
9201 Calumet Ave
Munster, IN 46321-2807
Phone (219) 836-2022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100188330 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Network Inc | Past | Accepting new patients | |
| St Mary Medical Center Inc | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pulmonary Disease Physician
- Munster, IN
- NPI 1841254828
-
dba Powers Health Medical Group
- Family Medicine Physician
- Saint John, IN
- NPI 1457610487
-
dba St Mary Wound Clinic
- General Acute Care Hospital
- Hobart, IN
- NPI 1962504175
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421366400000",
"number": "1467439828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9201 CALUMET AVE",
"city": "MUNSTER",
"state": "IN",
"postal_code": "463212807",
"telephone_number": "219-836-2022",
"fax_number": "219-836-1072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2075 INDIANAPOLIS BLVD",
"city": "WHITING",
"state": "IN",
"postal_code": "463941948",
"telephone_number": "219-659-7000",
"fax_number": "219-659-9018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SRISUWANANUKORN",
"first_name": "SOMPOP",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2015-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "IN",
"license": "01030518",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "IN",
"license": "01030518",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100188330",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whiting, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.