NPIMap

Organization Active NPI

Burbank Medical Center SC

  • Internal Medicine Physician
  • Burbank, IL
National Provider Identifier
1700058898
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036088926 Issued in IL
Legal business name
BURBANK MEDICAL CENTER SC
Practice address
4817 W 83Rd St
Burbank, IL 60459-2790
Phone
(708) 425-3135
Fax
(708) 425-6884
NPI assigned
Mar 28, 2008
Last updated
Jul 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

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

Authorized official

Name
Jalal Dahshe, MDNPI 1790716967
Title
President
Phone
(708) 425-3135

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036088926 IL Primary
Obstetrics & Gynecology Physician 207V00000X 036054337 IL
Podiatrist 213E00000X 016002638 IL

Addresses

Primary practice location

4817 W 83Rd St
Burbank, IL 60459-2790

Mailing address

4817 W 83Rd St
Burbank, IL 60459-2790
Phone (708) 425-3135

Other identifiers 2

IdentifierTypeStateIssuer
01639156OtherILBLUE CROSS
036088926MedicaidIL

National Provider Directory

National Provider Directory

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": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1700058898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4817 W 83RD ST",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "604592790",
            "telephone_number": "708-425-3135",
            "fax_number": "708-425-6884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4817 W 83RD ST",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "604592790",
            "telephone_number": "708-425-3135",
            "fax_number": "708-425-6884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURBANK MEDICAL CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-28",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "DAHSHE",
        "authorized_official_first_name": "JALAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-425-3135",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036088926",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036054337",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016002638",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "01639156",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088926",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.