Southside Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

336.073573 Issued in IL

Legal business name

SOUTHSIDE FAMILY MEDICINE PC

Practice address

1525 E 55TH St
Suite 307
Chicago, IL 60615-5512

Phone

(773) 667-5577

Fax

(773) 667-9977

NPI assigned

Jun 19, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Carlos J. Crudup, MD

Title

President

Phone

(773) 667-5577

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Collette Ara Honore, M.D.

  • Dermatology Physician
  • Chicago, IL
  • NPI 1174636930
  NPD (past)

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1922361450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1446 E 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606372948",
            "telephone_number": "773-230-2741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E 55TH ST",
            "address_2": "SUITE 307",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155512",
            "telephone_number": "773-667-5577",
            "fax_number": "773-667-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "CRUDUP",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-667-5577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "336.073573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southshore Medi Lab Inc
• Southside Health Association
• Southside Primary Care Group SC
• Southtown Medical Center, LLC
• Southview Manor Operator LLC
• Southview Manor,Inc

• 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 Jun 19, 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.