NPIMap

Organization Active NPI

Suburban Medical Group Corp

  • Urgent Care Clinic/Center
  • Bolingbrook, IL
National Provider Identifier
1871180901
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SUBURBAN MEDICAL GROUP CORP
Practice address
693 W Boughton Rd
Bolingbrook, IL 60440-1752
Phone
(630) 464-2627
NPI assigned
Dec 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Mohd. Mohiuddin, MDNPI 1154685089
Title
President
Phone
(630) 326-8766

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X
Urgent Care Clinic/Center 261QU0200X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

693 W Boughton Rd
Bolingbrook, IL 60440-1752

Mailing address

693 W Boughton Rd
Bolingbrook, IL 60440-1752
Phone (630) 326-8766

Other names 1

  • Suburban Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210203002845 IL Part B Supplier - Clinic/Group Practice 3476967399 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Bolingbrook, IL; Carol Stream, IL

Other NPIs on the same Medicare enrollment 1

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

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
14D2231616Suburban Medical Group693 W Boughton Rd, Bolingbrook, IL 60440Certificate of waiverAug 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Suburban Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

693 W Boughton Rd
Bolingbrook, IL 60440
Phone (630) 326-8766

Practitioners & affiliated clinicians

Practitioners 7

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": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1871180901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "693 W BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401752",
            "telephone_number": "630-326-8766",
            "fax_number": "630-326-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "693 W BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401752",
            "telephone_number": "630-464-2627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN MEDICAL GROUP CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "MOHIUDDIN",
        "authorized_official_first_name": "MOHD.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-326-8766",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suburban Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.