Datta Sambare M D S C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

DATTA SAMBARE M D S C

Doing business as

Madison Parkside Medical Center

Practice address

5650 W Madison St
Chicago, IL 60644-3939

Phone

(773) 379-2304

NPI assigned

Jun 22, 2006

Organization subpart

Yes

Parent organization

DATTA SAMBARE M D S CAs reported in NPPES

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

Authorized official

Name

Datta Sambare, M.D.NPI 1619911211

Title

President

Phone

(773) 379-2304

Specialties & licenses 1

Addresses

Other names 1

• Madison Parkside Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Datta Sambare M D S C

  dba Brookville Medical Center

  • Family Medicine Physician
  • Bolingbrook, IL
  • NPI 1780606566

  O20041018000376

  Same enrollment

Part of

Datta Sambare M D S C

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Datta Sambare, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1619911211
  NPD Authorized official

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1821034224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 215",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605590215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5650 W MADISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606443939",
            "telephone_number": "773-379-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DATTA SAMBARE M D S C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DATTA SAMBARE M D S C",
        "enumeration_date": "2006-06-22",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "SAMBARE",
        "authorized_official_first_name": "DATTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-379-2304",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Parkside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jehannaz Dastoor
• Revati Mohan Date
• Keaira Dates
• Katherine Dato, DNP
• Amanda M. Datson, OTR/L
• Indrany Datta-Barua, MD
• Swati Datta, D.O.
• Karen Dattalo, PHARMD
• Melanie Datu, PHARMD
• Trang Dau, MD

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.