Suresh Bhalla, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

036062964 Issued in IL

Practice address

210 N Hammes Ave
Suite 112
Joliet, IL 60435-6680

Phone

(815) 744-2054

Fax

(815) 744-5823

NPI assigned

Jul 8, 2005

Last updated

Nov 21, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 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 Medicine

State licenses

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479686400000",
    "number": "1811995426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N HAMMES AVE",
            "address_2": "SUITE 112",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356680",
            "telephone_number": "815-744-2054",
            "fax_number": "815-744-5823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N HAMMES AVE",
            "address_2": "SUITE 112",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356680",
            "telephone_number": "815-744-2054",
            "fax_number": "815-744-5823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHALLA",
        "first_name": "SURESH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2016-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036062964",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036062964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062964",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Joliet, IL
• Providers in Joliet, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.