Active NPI
Mathis Sutherlin
- Driver
- Chicago, IL
National Provider Identifier
1851034946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- S36454084348
- Practice address
- 6611 S Champlain Ave
Chicago, IL 60637-4101 - Phone
- (312) 709-7158
- NPI assigned
- Apr 16, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | S36454084348 | IL | Primary |
Addresses
Primary practice location
6611 S Champlain Ave
Chicago, IL 60637-4101
Mailing address
6611 S Champlain Ave # 4
Chicago, IL 60637-4101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S36454084348 | IL | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650067200000",
"number": "1851034946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6611 S CHAMPLAIN AVE # 4",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606374101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6611 S CHAMPLAIN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606374101",
"telephone_number": "312-709-7158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLIN",
"first_name": "MATHIS",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-16",
"last_updated": "2022-04-16",
"certification_date": "2022-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "IL",
"license": "S36454084348",
"primary": true
}
],
"identifiers": [],
"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 Apr 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.