Roosevelt Road Clinic MD SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036056560 Issued in IL

Legal business name

ROOSEVELT ROAD CLINIC MD SC

Practice address

3600 W Roosevelt Rd
Chicago, IL 60624-4225

Phone

(773) 638-6761

Fax

(773) 638-6984

NPI assigned

Apr 12, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Subarna P Pradhan, M.D.

Title

President

Phone

(773) 638-6761

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460419200000",
    "number": "1952765232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606244225",
            "telephone_number": "773-638-6761",
            "fax_number": "773-638-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606244225",
            "telephone_number": "773-638-6761",
            "fax_number": "773-638-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT ROAD CLINIC MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-12",
        "last_updated": "2016-04-12",
        "status": "A",
        "authorized_official_last_name": "PRADHAN",
        "authorized_official_first_name": "SUBARNA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-638-6761",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036056560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036056560",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "636231",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Roop
• Cameron Roorda, DPT
• Madeline Roos, LPC
• Raymond Roos
• Arturo Roosen, PA-C
• Hannah Roosevelt, MS, RD, LDN, CNSC
• Root & Vines Wellness, PLLC
• Root Acupuncture and Herbal Therapy Inc
• Root and Branch Parenthood
• Root and Rise Psychological Services PLLC

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.