Active NPI
Panjaporn Supanwanid Henrich, M.D.
- Physical Medicine & Rehabilitation Physician
- Chicago, IL
National Provider Identifier
1942496781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 036120204
- Practice address
- 355 E Erie St
Chicago, IL 60611-3167 - Phone
- (312) 238-1000
- Fax
- (312) 238-5846
- NPI assigned
- Sep 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 036120204 | IL | Primary |
Addresses
Primary practice location
355 E Erie St
Chicago, IL 60611-3167
Mailing address
355 E Erie St
Chicago, IL 60611-3167
Phone (312) 238-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036120204-1 | Medicaid | IL |
Other names 1
- Dr. Panjaporn Supanwanid
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | psupanwanid@direct.ric.org | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- psupanwanid@direct.ric.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656028800000",
"number": "1942496781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "355 E ERIE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113167",
"telephone_number": "312-238-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 E ERIE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113167",
"telephone_number": "312-238-1000",
"fax_number": "312-238-5846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPANWANID HENRICH",
"first_name": "PANJAPORN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-14",
"last_updated": "2022-06-24",
"certification_date": "2022-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IL",
"license": "036120204",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036120204-1",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "psupanwanid@direct.ric.org",
"affiliation": "N",
"endpointDescription": "Shirley Ryan AbilityLab",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "referrals",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "xml",
"address_1": "355 E Erie St",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606113167",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "PANJAPORN",
"last_name": "SUPANWANID",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}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 Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.