NPIMap

Suraj Bopanna, MD, MRCP

Individual provider Active NPI Pulmonary Disease Physician · Rockford, IL

NPI 1740433291 · NPPES record last updated Mar 4, 2024

Key facts

NPI
1740433291
Entity type
Individual (NPI type 1)
Primary specialty
Pulmonary Disease Physician 207RP1001X
License
036-126456 (IL)
Practice address
1401 E State St
Rockford, IL 61104
Phone
(779) 696-6102
NPI assigned
Oct 28, 2008
Sex
Male
Sole proprietor
No

Organizations & group practices 36

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.

View all 36

Hospital & facility affiliations 5

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

Medicare Care Compare profile

Specialty
Pulmonary Disease
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc. (3,764 clinicians)
Swedishamerican Hospital (386 clinicians)
Morrison Community Hospital District (40 clinicians)

Practice addresses (Care Compare)

13250 Washington Ave
Mount Pleasant, WI 53177-1516
Phone (262) 884-4000

1401 E State St
Rockford, IL 61104-2315
Phone (815) 489-4400

303 N Jackson St
Morrison, IL 61270-3042
Phone (815) 772-4003

Hospital & facility affiliations

  • Uw Health Hospital · Rockford, IL · CCN 140228
  • Aurora Baycare Medical Ctr Hospital · Green Bay, WI · CCN 520193
  • Morrison Community Hospital Hospital · Morrison, IL · CCN 141329
  • CGH Medical Center Hospital · Sterling, IL · CCN 140043
  • Aurora Medical Ctr Manitowoc County Hospital · Two Rivers, WI · CCN 520034

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in IA, IL, WI
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20130718000095 IA Practitioner - Pulmonary Disease
Practitioner - Critical Care (Intensivists)
Practitioner - Internal Medicine		 9436390325 Reassigns benefits to 1 organization
I20161005000384 IL Practitioner - Pulmonary Disease 9436390325 Reassigns benefits to 8 organizations
I20211012003134 WI Practitioner - Pulmonary Disease 9436390325 Reassigns benefits to 3 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
40265IAMDPulmonary Disease Physician
036-126456ILMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital Current
since Nov 1, 2016		 Accepting new patients
Mercy Medical Center Current
since Feb 1, 2023		 Accepting new patients
Morrison Community Hospital District Current Accepting new patients
Osf Multi-Specialty Group Internal Medicine Current
since Apr 1, 2022		 Accepting new patients
Osf Multi-Specialty Group Internal Medicine Current
since Apr 1, 2022		 Accepting new patients
CGH Medical Center Current Accepting new patients
Freeport Memorial Hospital Current
since Jul 1, 2018		 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Internal Medicine Current
since Oct 1, 2021		 Accepting new patients
Rockford Health Physicians Current
since Nov 12, 2023		 Accepting new patients
Critical Care Physicians of Illinois LLC Critical Care Medicine Current
since Dec 14, 2022		 Accepting new patients
CGH Medical Center Current
since Jan 9, 2023		 Accepting new patients
Morrison Community Hospital District Current
since Sep 13, 2022		 Accepting new patients
Aurora Medical Group, Inc. Current
since Jul 1, 2022		 Accepting new patients
Mercy Medical Center Current Accepting new patients
Morrison Community Hospital District Current
since Sep 13, 2022		 Accepting new patients
Swedishamerican Hospital Internal Medicine Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Current
since Oct 1, 2021		 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Current
since Oct 1, 2021		 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Aurora Medical Group, Inc. Internal Medicine Current
since Jul 1, 2022		 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Internal Medicine Current
since Oct 1, 2021		 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Internal Medicine Current Accepting new patients
CGH Medical Center Current
since Jan 9, 2023		 Accepting new patients
Swedishamerican Hospital Current
since Nov 1, 2016		 Accepting new patients
Mercy Medical Center Current
since Feb 1, 2023		 Accepting new patients

Locations

701 10th St SE
Cedar Rapids, IA 52403
Phone (319) 398-6011

788 8th Ave SE
Ste 200
Cedar Rapids, IA 52401
Phone (319) 221-8788

800 W Central Rd
Arlington Hts, IL 60005
Phone (847) 618-6150

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

800 N Logan Ave
Ste 204
Danville, IL 61832
Phone (217) 431-4080

1045 W Stephenson St
Freeport, IL 61032
Phone (815) 599-6105

303 N Jackson St
Morrison, IL 61270
Phone (815) 772-4003

657 W Lincolnway
Morrison, IL 61270
Phone (815) 772-4003

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

13250 Washington Ave
Mount Pleasant, WI 53177
Phone (262) 799-8330

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Interoperability endpoints

  • Direct secure messaging: sbopanna359568@direct.myadvocateaurora.org
  • Direct secure messaging: kgannonloew29183@direct.uwhealth.org
  • Direct secure messaging: sbopannamd915145@direct.uwhealth.org
  • Direct secure messaging: surajbopanna@mchospital.medalliesdirect.net

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 40265 IA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 40265 IA
Pulmonary Disease Physician 207RP1001X 40265 IA
Pulmonary Disease Physician 207RP1001X 036-126456 IL Yes
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036-126456 IL

Addresses

Primary practice location

1401 E State St
Rockford, IL 61104

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Other identifiers

IdentifierTypeStateIssuer
100181898MedicaidWI

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address sbopannamd915145@direct.uwhealth.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2
Direct Messaging Address sbopanna359568@direct.myadvocateaurora.org Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 4, 2024.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1740433291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150",
            "fax_number": "779-696-7342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61104",
            "telephone_number": "779-696-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOPANNA",
        "first_name": "SURAJ",
        "name_prefix": "Mr.",
        "credential": "MD, MRCP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-28",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "40265",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IA",
            "license": "40265",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IA",
            "license": "40265",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036-126456",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036-126456",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100181898",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbopannamd915145@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1401 E State St",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61104",
            "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": "2845 Greenbrier Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543116519",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbopanna359568@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2845 Greenbrier Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543116519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rockford, IL

All providers in Rockford, IL · Pulmonary Disease Physician in Illinois

Sources for this page

Verify at the official NPI Registry.