NPIMap

Organization Active NPI

Medical Diagnostic Services Inc

  • Physiological Laboratory
  • Skokie, IL
National Provider Identifier
1952568636
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MEDICAL DIAGNOSTIC SERVICES INC
Practice address
3701 Jarvis Ave
Skokie, IL 60076-4019
Phone
(847) 626-0800
Fax
(847) 626-0819
NPI assigned
May 20, 2008
Last updated
May 29, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDICAL DIAGNOSTIC SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Authorized official

Name
Mr. Shams U Siddiqui
Title
Ceo
Phone
(847) 626-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X NU Primary

Addresses

Primary practice location

3701 Jarvis Ave
Skokie, IL 60076-4019

Mailing address

3701 Jarvis Ave
Skokie, IL 60076-4019
Phone (847) 626-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080407000692 IL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 5890893275 Practice locations: Skokie, IL

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Medical Diagnostic SVCS Inc

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1952568636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 JARVIS AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600764019",
            "telephone_number": "847-626-0800",
            "fax_number": "847-626-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 JARVIS AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600764019",
            "telephone_number": "847-626-0800",
            "fax_number": "847-626-0819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL DIAGNOSTIC SERVICES INC",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "SHAMS",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-626-0800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.