Suresh H Wadhwani, M.D. S.C.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

036073974 Issued in IL

Practice address

100 Provena Way
Bourbonnais, IL 60914-4796

Phone

(815) 936-3200

NPI assigned

Feb 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Cardiovascular Disease (Cardiology)

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prime Healthcare Illinois Medical Group LLCGroup PAC ID 5597275685, 278 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence St Marys Hospital Hospital, Kankakee, IL, CCN 140155
• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186
• Iroquois Memorial Hospital Hospital, Watseka, IL, CCN 141353

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: suresh.wadhwani.1@15486.direct.athenahealth.com

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.

• Prime Healthcare Illinois Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1023837689
  Medicare reassignment Care Compare group NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Iroquois Memorial Hospital and Resident Home

  • Critical Access Hospital
  • Watseka, IL
  • NPI 1629003470
  Care Compare affiliation
• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation
• St Marys Hospital - Kankakee LLC

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1467290809
  Care Compare affiliation

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1659406510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 W COURT ST",
            "address_2": "SUITE 302",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013679",
            "telephone_number": "815-936-3250",
            "fax_number": "815-936-3253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROVENA WAY",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144796",
            "telephone_number": "815-936-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADHWANI",
        "first_name": "SURESH",
        "middle_name": "H",
        "credential": "M.D. S.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036073974",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036073974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073974",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swadhwani115162@ce-direct.presencehealth.org",
            "affiliation": "N",
            "address_1": "100 Provena Way",
            "city": "Bourbonnais",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609144796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joel P Villegas, MD
• Vishwam, Inc (Bourbonnais Pharmacy)
• Vishwam, Inc (Bourbonnais Pharmacy)
• Vitality Family Medical & Wellness PLLC
• Vna Home Health of Illinois LTD (VNA Healthtrends South)
• Frederick P Waldschmidt, D.D.S.
• Walgreen Co (Walgreens #10339)
• Walgreen Co. (Walgreens #10339)
• Dalene Wallace
• Walmart Inc.

• Cardiovascular Disease Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Cardiovascular Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.