NPIMap

Organization Active NPI

Southwestern Medical Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Bedford Park, IL
National Provider Identifier
1790710390
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
7002264 Issued in IL
Legal business name
SOUTHWESTERN MEDICAL CENTER, LLC
Practice address
7456 S State Rd, Ste 300
Third Floor
Bedford Park, IL 60638-6621
Phone
(773) 445-9696
Fax
(773) 445-9590
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Authorized official

Name
Kenny Bozorgi, MDNPI 1255568333
Title
Ceo
Phone
(773) 445-9696

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X IL
Ambulatory Surgical Clinic/Center 261QA1903X 7002264 IL Primary

Addresses

Primary practice location

7456 S State Rd, Ste 300
Third Floor
Bedford Park, IL 60638-6621

Mailing address

PO Box 88724
Carol Stream, IL 60188-8724
Phone (773) 445-9696

Other names 1

  • Magna Surgical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110630000516 IL Part B Supplier - Ambulatory Surgical Center 0345428967 Practice locations: Bedford Park, IL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Southwestern Medical Center LLCCCN 14C0001025
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2025694Southwestern Medical Center LLC (D/B/a)7456 S State Rd, 3Rd FL, Bedford Park, IL 60638Certificate of waiverJun 14, 2027

National Provider Directory

National Provider Directory

Locations

9831 S Western Ave
Lowr
Chicago, IL 60643
Phone (773) 445-9696

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675382400000",
    "number": "1790710390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88724",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601888724",
            "telephone_number": "773-445-9696",
            "fax_number": "773-445-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7456 S STATE RD, STE 300",
            "address_2": "THIRD FLOOR",
            "city": "BEDFORD PARK",
            "state": "IL",
            "postal_code": "606386621",
            "telephone_number": "773-445-9696",
            "fax_number": "773-445-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A",
        "authorized_official_last_name": "BOZORGI",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-445-9696",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magna Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magna Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bedford Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.