Individual provider Active NPI

Sivaraja Kuppuswami, M.D.

  • Diagnostic Radiology Physician
  • Downers Grove, IL
National Provider Identifier
1780747600
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Practice address
3815 Highland Ave
Good Samaritan Hospital
Downers Grove, IL 60515-1500
Phone
(630) 873-5436
NPI assigned
Dec 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X IL Primary

Addresses

Primary practice location

3815 Highland Ave
Good Samaritan Hospital
Downers Grove, IL 60515-1500

Mailing address

520 E 22ND St
Lombard, IL 60148-6110
Phone (630) 874-2542

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070515000083 IL Practitioner - Diagnostic Radiology 2365549086 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Traverse Radiologists PCGroup PAC ID 6002866407, 32 clinicians
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

147 Ravine Rd
Hinsdale, IL 60521-3742
Phone (773) 213-8685

2650 Ridge Ave
Suite 2218a
Evanston, IL 60201-1700
Phone (847) 503-4222

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081
  • Munson Healthcare Grayling Hospital Hospital, Grayling, MI, CCN 230058
  • Munson Healthcare Otsego Memorial Hospital Hospital, Gaylord, MI, CCN 230133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Aug 1, 2015 Accepting new patients
Radiology Associates of Appleton, S.C. Diagnostic Radiology CurrentSince Jan 1, 2016 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 1, 2015 Accepting new patients
Grand Traverse Radiologists PC Diagnostic Radiology CurrentSince Oct 1, 2024 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1780747600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E 22ND ST",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601486110",
            "telephone_number": "630-874-2542",
            "fax_number": "630-874-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 HIGHLAND AVE",
            "address_2": "GOOD SAMARITAN HOSPITAL",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151500",
            "telephone_number": "630-873-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPPUSWAMI",
        "first_name": "SIVARAJA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

Verify at the official NPI Registry.