Brad L Suprenant, DO

Primary specialty

Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X

License

036071427 Issued in IL

Practice address

500 N Wall St
Kankakee, IL 60901-2942

Phone

(844) 404-4787

Fax

(815) 936-3243

NPI assigned

Dec 7, 2005

Last updated

Mar 29, 2021By the provider in NPPES

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 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bsuprenant7932@direct.riversidehealthcare.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  Medicare reassignment NPD
• Riverside Health System

  dba Psychiatric Associates

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

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

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1760467377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "844-404-4787",
            "fax_number": "815-936-3243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "844-404-4787",
            "fax_number": "815-936-3243"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "375 N Wall St Ste P420",
            "address_purpose": "LOCATION",
            "city": "Kankakee",
            "state": "IL",
            "postal_code": "60901",
            "country_code": "US",
            "telephone_number": "815-939-9400",
            "fax_number": "815-939-9494",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1490 E Walnut St Ste A",
            "address_purpose": "LOCATION",
            "city": "Watseka",
            "state": "IL",
            "postal_code": "609701806",
            "country_code": "US",
            "telephone_number": "815-432-7693",
            "fax_number": "815-936-7228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPRENANT",
        "first_name": "BRAD",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IL",
            "license": "036071427",
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IN",
            "license": "02001098A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "060030169",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000095316",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036071247",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bsuprenant7932@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "endpointDescription": "Direct, Secure Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 N Wall St",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609012942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather Rae Stroo, FNP-BC
• Subhendu Sinhamahapatra MD SC
• Mobolaji B Suleiman, MD
• Qatrice Sumrall
• Stephen Supple, MD
• Surecare Health Pharmacy Inc (Surecare Health Pharmacy)
• Suresh H. Wadhwani, MD, SC
• Matthew Sutherland
• Deborah Ann Sutton, LCSW
• Charles Earl Swanson, DO

• Clinical Cardiac Electrophysiology Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Clinical Cardiac Electrophysiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.