Individual provider Active NPI

Surichhya Bajracharya, MD

  • Neonatal-Perinatal Medicine Physician
  • Chicago, IL
National Provider Identifier
1588046882
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
036148744 Issued in IL
Practice address
836 W Wellington Ave
Chicago, IL 60657-5147
Phone
(847) 723-5313
NPI assigned
Jun 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 036148744 IL Primary

Addresses

Primary practice location

836 W Wellington Ave
Chicago, IL 60657-5147

Mailing address

29373 Network PL
Chicago, IL 60673-5147

Other practice location 1

155 55th St
Lutheran Medical Center
Brooklyn, NY 11220
Phone (718) 630-6374

Other practice location 2

1675 Dempster St
Park Ridge, IL 60068
Phone (847) 318-9300

Other practice location 3

1675 Dempster St
Park Ridge, IL 60068
Phone (847) 318-9300

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address sbajracharya229086@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20220929001688 IL Practitioner - Pediatric Medicine 2668858531 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036148744ILMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Oct 7, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Oct 7, 2022 Accepting new patients

Locations

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

836 W Wellington Ave
Chicago, IL 60657
Phone (773) 296-7054

29373 Network Pl
Chicago, IL 60673

1675 W Dempster St
Park Ridge, IL 60068
Phone (847) 318-9300

Interoperability endpoints

  • Direct secure messaging: sbajracharya229086@direct.myadvocateaurora.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1588046882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 W WELLINGTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575147",
            "telephone_number": "847-723-5313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 55th St",
            "address_2": "Lutheran Medical Center",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11220",
            "country_code": "US",
            "telephone_number": "718-630-6374",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1675 Dempster St",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "60068",
            "country_code": "US",
            "telephone_number": "847-318-9300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1675 Dempster St",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "60068",
            "country_code": "US",
            "telephone_number": "847-318-9300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAJRACHARYA",
        "first_name": "SURICHHYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-23",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036148744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbajracharya229086@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "836 W Wellington Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606575147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "836 W Wellington Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606575147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.