Organization Active NPI

Center for Brain and Nerve Disorders S.C.

  • Neurology Physician
  • Orland Park, IL
National Provider Identifier
1508299611
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036.115847 Issued in IL
Legal business name
CENTER FOR BRAIN AND NERVE DISORDERS S.C.
Practice address
10723 Winterset Dr
Orland Park, IL 60467-1106
Phone
(708) 675-7110
Fax
(708) 310-3430
NPI assigned
Aug 12, 2013
Last updated
Dec 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

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

Authorized official

Name
Dr. Sreepathy Kannan, M.D.NPI 1295793529
Title
President
Phone
(630) 258-1499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036.115847 IL Primary

Addresses

Primary practice location

10723 Winterset Dr
Orland Park, IL 60467-1106

Mailing address

8S323 Hampton Cir
Naperville, IL 60540-9322
Phone (708) 675-7110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131015000589 IL Part B Supplier - Clinic/Group Practice 5496989071 Receives reassigned benefits from 1 practitioner
Practice locations: Orland Park, IL

National Provider Directory

National Provider Directory

Locations

396 Remington Blvd
Ste 360
Bolingbrook, IL 60440
Phone (630) 789-9785

18327 Distinctive Dr
Orland Park, IL 60467
Phone (708) 675-7110

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387756800000",
    "number": "1508299611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8S323 HAMPTON CIR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605409322",
            "telephone_number": "708-675-7110",
            "fax_number": "630-778-3971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10723 WINTERSET DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604671106",
            "telephone_number": "708-675-7110",
            "fax_number": "708-310-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR BRAIN AND NERVE DISORDERS S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-12-23",
        "status": "A",
        "authorized_official_last_name": "KANNAN",
        "authorized_official_first_name": "SREEPATHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-258-1499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036.115847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; 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.