Individual provider Active NPI

Martin John Labuda Jr., D.C

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1841316973
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-009597 Issued in IL
Practice address
3832 N Broadway St
Chicago, IL 60613-3218
Phone
(773) 296-2225
Fax
(773) 296-0731
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-009597 IL Primary
Sports Physician Chiropractor 111NS0005X 038-009597 IL

Addresses

Primary practice location

3832 N Broadway St
Chicago, IL 60613-3218

Mailing address

3832 N Broadway St
Chicago, IL 60613-3218
Phone (773) 296-2225

Other identifiers 3

IdentifierTypeStateIssuer
4063763OtherILCIGNA PIN
01632439OtherILBLUE CROSS BLUE SHIELD #
IL7546001OtherILMEDICARE INDIVIDUAL PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121012000548 IL Practitioner - Chiropractic 7214186964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Martin J Labuda DC PCGroup PAC ID 6305095043, 2 clinicians

Practice addresses (Care Compare)

3832 N Broadway St
Chicago, IL 60613-3218
Phone (773) 296-2225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-009597ILMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Martin J. Labuda, DC, PC Chiropractor CurrentSince Oct 12, 2012 Accepting new patients
Paul T. Hackett D.C., P.C. Chiropractor Past Accepting new patients

Locations

3832 N Broadway St
Chicago, IL 60613
Phone (773) 296-2225

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1841316973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3832 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133218",
            "telephone_number": "773-296-2225",
            "fax_number": "773-296-0731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3832 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133218",
            "telephone_number": "773-296-2225",
            "fax_number": "773-296-0731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABUDA",
        "first_name": "MARTIN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-009597",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": "038-009597",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "4063763",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "01632439",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "IL7546001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; 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.