Individual provider Active NPI

Tina Sundaram, M.D.

  • Emergency Medicine Physician
  • Bronx, NY
National Provider Identifier
1982991477
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036-138402 Issued in IL
Practice address
1400 Pelham Pkwy S
BLDG 6, Ste. 1B-25
Bronx, NY 10461-1138
Phone
(718) 918-5820
NPI assigned
Jul 5, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-138402 IL Primary

Addresses

Primary practice location

1400 Pelham Pkwy S
BLDG 6, Ste. 1B-25
Bronx, NY 10461-1138

Mailing address

1653 W. Congress Pkwy
177 Murdock
Chicago, IL 60612-3833
Phone (312) 947-0229

Other names 1

  • Tina Wadhwa Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151223001837 IL Practitioner - Emergency Medicine 8921309576 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1653 W Congress Pkwy
Chicago, IL 60612-3833

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-138402ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group Emergency Medicine CurrentSince Oct 1, 2020 Accepting new patients
Cook County Current Accepting new patients
Rush Oak Park ER Physicians Group CurrentSince Feb 8, 2021 Accepting new patients
Rush University Medical Center CurrentSince Oct 1, 2020 Accepting new patients
Cook County Emergency Medicine CurrentSince Aug 18, 2017 Accepting new patients
Cook County CurrentSince Aug 18, 2017 Accepting new patients
Jacobi Medical Center Ed Past Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

1653 W Congress Pkwy
#177
Chicago, IL 60612
Phone (312) 947-0229

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

75 Remittance Dr
Dept 1620
Chicago, IL 60675

520 S Maple Ave
Oak Park, IL 60304
Phone (708) 383-9300

Interoperability endpoints

  • Direct secure messaging: tsundaram122762@direct.rush.rush-health.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1982991477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 W. CONGRESS PKWY",
            "address_2": "177 MURDOCK",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-947-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "address_2": "BLDG 6, STE. 1B-25",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611138",
            "telephone_number": "718-918-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARAM",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-05",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-138402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "WADHWA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.