Montha Suphangul, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

125052160 Issued in IL

Practice address

355 Ridge Ave
Evanston, IL 60202-3328

Phone

(847) 316-4000

NPI assigned

Jul 11, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Midwest Neoped Associates LTD

  • Specialist
  • Oak Brook, IL
  • NPI 1396792180
  NPD (past)

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1548424229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 CUSTER AVE APT 2G",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022975",
            "telephone_number": "773-273-5968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023328",
            "telephone_number": "847-316-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPHANGUL",
        "first_name": "MONTHA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125052160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD PPO",
            "identifier": "XOF839694314",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renee Ann Summers, M.S.W.,L.C.S.W.
• Bob Sun, M.D.
• Sunflower Clinical Group LTD
• Sunflower Clinical Group LTD
• Sunny Days, LLC
• Rachel Marie Supple, PA-C
• Stjepan Surbek, MD
• Avni Suresh, APN-CRNA
• Sunitha Chitra Suresh, MD
• Renee Surgi, LCSW

• Internal Medicine Physician in Evanston, IL
• Providers in Evanston, 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 Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.