South Suburban Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SOUTH SUBURBAN PEDIATRICS

Practice address

165 W 10TH St
Chicago Heights, IL 60411-2000

Phone

(708) 754-3507

NPI assigned

Jun 19, 2006

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

Mrs. Jeanette Bass-Jordan

Title

Executive Director

Phone

(708) 754-3507

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952346215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 W 10TH ST",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112000",
            "telephone_number": "708-754-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 W 10TH ST",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112000",
            "telephone_number": "708-754-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SUBURBAN PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BASS-JORDAN",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-754-3507",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Pediatrics Physician 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.