Suburban Diagnostic Inc

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

License

500483643 Issued in IL

Legal business name

SUBURBAN DIAGNOSTIC INC

Practice address

11600 Legacy Dr
Plainfield, IL 60585-5194

Phone

(815) 577-8200

Fax

(815) 577-8300

NPI assigned

Apr 17, 2007

Last updated

May 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Glenn Padilla, RTNPI 1558434001

Title

Owner

Phone

(815) 577-8200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740406107. Details of each certification follow.

• CCN 14X0009866 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 14X0009866

Legal name

SUBURBAN DIAGNOSTIC INC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jun 27, 2000

Last certification

Dec 30, 2020

Ownership / control type

Corporation

Facility address

11600 Legacy Drive
Plainfield, IL 60585

Practitioners 2

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.

• Glenn B. Padilla, X-RAY TECH

  • Radiography Radiologic Technologist
  • Plainfield, IL
  • NPI 1558434001
  NPD Authorized official
• Ailyn L. Padilla, NP

  • Gerontology Nurse Practitioner
  • Lisle, IL
  • NPI 1831963198
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1740406107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11600 LEGACY DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605855194",
            "telephone_number": "815-577-8200",
            "fax_number": "815-577-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 LEGACY DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605855194",
            "telephone_number": "815-577-8200",
            "fax_number": "815-577-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN DIAGNOSTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "PADILLA",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-577-8200",
        "authorized_official_credential": "RT"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "IL",
            "license": "500483643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364369726001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09932186",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nashayla Faye Strickling
• Robert Stroud
• Christian Paul Struven III, M.D.
• Scott David Stuck, D.C.
• Stacie Britt Stuck, D.C.
• Suburban Foot & Ankle Associates, Inc
• Success Nurse Agency Inc
• Successful Kids
• Ashish Sud, D.C
• David Suire, PH.D.

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Plainfield, IL
• Providers in Plainfield, IL by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.