Pong Medical Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036048043 Issued in IL

Legal business name

PONG MEDICAL CENTER LLC

Practice address

5151 N Lincoln Ave
Chicago, IL 60625-2520

Phone

(773) 784-0900

Fax

(773) 784-6173

NPI assigned

May 20, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Suchat Ponglorpisita, MD

Title

MD

Phone

(773) 218-9625

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1337472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1871853259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MARTINDALE DR",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601544920",
            "telephone_number": "773-218-9625",
            "fax_number": "773-784-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252520",
            "telephone_number": "773-784-0900",
            "fax_number": "773-784-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONG MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-20",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "PONGLORPISITA",
        "authorized_official_first_name": "SUCHAT",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "773-218-9625",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036048043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Allan Poncinie, OTR
• Jacqueline Wilneff Ponczek, M.D., M.S.
• Karyn Pondel, LMT
• Ponder Mental Wellness, PLLC
• Haritha Ponduri, MSN, APRN, FNP-C
• Supachai S Pongched, M.D.
• Jacqueline Ann Pongracic, MD
• Abigail Poniente Monsalud
• Natalya Igorevna Ponomareva, MD
• Ponos Care Illinois, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.