Suburban Wellness SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036119041 Issued in IL

Legal business name

SUBURBAN WELLNESS SC

Practice address

15750 S Bell Rd Ste 2D
Homer Glen, IL 60491-8420

Phone

(708) 737-7136

Fax

(708) 887-5886

NPI assigned

Oct 29, 2013

Organization subpart

No

Name

Dr. Sudarsana Chakrabarti, MDNPI 1104096940

Title

Owner

Phone

(708) 737-7136

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sudarsana Chakrabarti, MD

  • Cardiovascular Disease Physician
  • Homer Glen, IL
  • NPI 1104096940

  IL

  Medicare reassignment NPD Authorized official

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 6, 2017.

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1871921999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 CIRCLE RIDGE DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605278380",
            "telephone_number": "708-737-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15750 S BELL RD STE 2D",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604918420",
            "telephone_number": "708-737-7136",
            "fax_number": "708-887-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN WELLNESS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "CHAKRABARTI",
        "authorized_official_first_name": "SUDARSANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-737-7136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036119041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Catrice Spiva
• Rana Srour, DMD
• Step by Step Behavior Therapy
• Douglas S Stevens, PA-C
• Agnieszka Stryjek
• Natalie Swartz
• Derek Szeliga, PHARMD
• Muhammad Taha, PHARMD
• Emily Taylor
• TD Fewkes LLC

• All providers in Homer Glen, IL
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; 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.