Organization Active NPI

Chicago Lake Shore Medical Associates,LTD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1912946120
Registry record updated Jul 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CHICAGO LAKE SHORE MEDICAL ASSOCIATES,LTD
Practice address
676 N St Clair
Suite 2300
Chicago, IL 60611-2922
Phone
(312) 926-6000
Fax
(312) 276-4032
NPI assigned
Jun 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2012

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

Authorized official

Name
Mrs. Linda D Marra, CPC
Title
Practice Manager
Phone
(312) 926-6101

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Sleep Disorder Diagnostic Clinic/Center 261QS1200X

Addresses

Primary practice location

676 N St Clair
Suite 2300
Chicago, IL 60611-2922

Mailing address

676 N St Clair
Suite 2300
Chicago, IL 60611-2922
Phone (312) 926-6000

National Provider Directory

National Provider Directory

Locations

Dept 4373
Carol Stream, IL 60122

676 N Saint Clair St
Ste 300
Chicago, IL 60611
Phone (312) 787-2773

676 N Saint Clair St
Ste 370
Chicago, IL 60611
Phone (312) 787-6662

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343001600000",
    "number": "1912946120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N ST CLAIR",
            "address_2": "SUITE 2300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112922",
            "telephone_number": "312-926-6000",
            "fax_number": "312-276-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N ST CLAIR",
            "address_2": "SUITE 2300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112922",
            "telephone_number": "312-926-6000",
            "fax_number": "312-276-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO LAKE SHORE MEDICAL ASSOCIATES,LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2012-07-23",
        "status": "A",
        "authorized_official_last_name": "MARRA",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "312-926-6101",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; 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.