Northside-Suburban Pediatric Associates, S.C.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

NORTHSIDE-SUBURBAN PEDIATRIC ASSOCIATES, S.C.

Practice address

4801 W Peterson Ave
Ste 506
Chicago, IL 60646-5795

Phone

(773) 777-5437

Fax

(773) 777-7567

NPI assigned

Jun 24, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Deutsch

Title

Administrator/Manager

Phone

(773) 777-5437

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902802770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE",
            "address_2": "STE 506",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465795",
            "telephone_number": "773-777-5437",
            "fax_number": "773-777-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE",
            "address_2": "STE 506",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465795",
            "telephone_number": "773-777-5437",
            "fax_number": "773-777-7567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE-SUBURBAN PEDIATRIC ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEUTSCH",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATOR/MANAGER",
        "authorized_official_telephone_number": "773-777-5437"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "01615555",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Chicago, IL
• Providers in Chicago, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.