South Chicago Sleep Lab, Inc.

Primary specialty

Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X

License

1769484 Issued in IL

Legal business name

SOUTH CHICAGO SLEEP LAB, INC.

Practice address

9011 S Commercial Ave
Suite 202
Chicago, IL 60617-4304

Phone

(773) 375-1845

NPI assigned

Nov 30, 2006

Last updated

Feb 22, 2008By 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

Sudeep Bisla

Title

President

Phone

(312) 955-8084

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shawn Kumar, MD

  • Pain Medicine (Anesthesiology) Physician
  • Chicago, IL
  • NPI 1043552953
  NPD (past)
• Kristina Marie Derolf, CRNA

  • Certified Registered Nurse Anesthetist
  • Munster, IN
  • NPI 1093090680
  NPD (past)

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1912074147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 N MCCLURG CT",
            "address_2": "#3207",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115359",
            "telephone_number": "312-545-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9011 S COMMERCIAL AVE",
            "address_2": "SUITE 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174304",
            "telephone_number": "773-375-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CHICAGO SLEEP LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "BISLA",
        "authorized_official_first_name": "SUDEEP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-955-8084"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "IL",
            "license": "1769484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1636864",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• South Chicago Parents and Friends, Inc.
• South Chicago Physicial Medicine
• South Chicago SLF, LLC
• South Haven Behavioral Modification II Inc
• South Lake Medical Services, LTD
• South Loop Endoscopy and Wellness Center LLC
• South Loop Integrated Physicians LTD

• Sleep Disorder Diagnostic Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Sleep Disorder Diagnostic Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; 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.