Individual provider Active NPI

Sujata Subramanian, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Temple, TX
National Provider Identifier
1487792057
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
S6748 Issued in TX
Practice address
2401 S 31St St
Temple, TX 76508-0002
Phone
(254) 724-2111
NPI assigned
Feb 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 036-126866 IL
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 35138048 OH
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD425377 PA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X S6748 TX Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-0002

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111

Other practice location 1

160 E Erie Ave
Philadelphia, PA 19134-1011
Phone (484) 628-1324

Other identifiers 1

IdentifierTypeStateIssuer
036-126866OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, TX, CA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20110204000614 IL Practitioner - Cardiac SurgeryPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Thoracic Surgery 2062545890 Reassigns benefits to 1 organization
I20200415000447 TX Practitioner - Thoracic SurgeryPractitioner - General Surgery 2062545890 Reassigns benefits to 2 organizations
I20241003003105 CA Practitioner - Thoracic Surgery 2062545890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Harvard Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shamsuddin Khwaja M D IncGroup PAC ID 5799810784, 8 clinicians

Practice addresses (Care Compare)

729 N Medical Ctr Dr W
Suite 223
Clovis, CA 93611-6885
Phone (559) 449-9990

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)18
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-126866ILMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dell Children's Medical Group CurrentSince Feb 8, 2021 Accepting new patients
The University of Texas Health Science Center at San Antonio CurrentSince May 1, 2020 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jul 1, 2014 Accepting new patients
STC Pediatrics LLC Current Accepting new patients
University of Texas Health Science Center at San Antonio Current Accepting new patients
Shamsuddin Khwaja M D Inc Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Aug 1, 2024 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jul 1, 2014 Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince May 1, 2020 Accepting new patients
Dell Children's Medical Group CurrentSince Feb 8, 2021 Accepting new patients

Locations

729 N Medical Center Dr W
Ste 223
Clovis, CA 93611
Phone (559) 449-9990

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

75 Remittance Dr
Dept 1611
Chicago, IL 60675

75 Remittance Dr
Ste 16
Chicago, IL 60675

29373 Network Pl
Chicago, IL 60673

3815 Highland Ave
Downers Grove, IL 60515
Phone (630) 275-5900

4440 W 95th St
Oak Lawn, IL 60453
Phone (708) 346-5520

160 E Erie Ave
Philadelphia, PA 19134
Phone (215) 427-4067

4910 Mueller Blvd
Ste 100
Austin, TX 78723
Phone (206) 543-3093

1301 Barbara Jordan Blvd
Ste 200
Austin, TX 78723
Phone (512) 628-1800

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

Organizations & group practices 9

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 2

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": "1170460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1487792057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080002",
            "telephone_number": "254-724-2111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Erie Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191341011",
            "country_code": "US",
            "telephone_number": "484-628-1324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUBRAMANIAN",
        "first_name": "SUJATA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-03",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036-126866",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "OH",
            "license": "35138048",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD425377",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TX",
            "license": "S6748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036-126866",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.