NPIMap

Organization Active NPI

Medical Diagnostic Services Inc

  • Diagnostic Radiology Physician
  • Skokie, IL
National Provider Identifier
1992962682
Registry record updated Jan 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
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
Organization subpart
Yes
Parent organization
MEDICAL DIAGNOSTIC SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2015

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X

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
O20071108000682 IL Part B Supplier - Clinic/Group Practice 5890893275 Receives reassigned benefits from 10 practitioners
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
Tax ID family
Medical Diag Services Inc6 organizations share this tax ID, including this one
Part of
Medical Diag Services Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

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 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1422144000000",
    "number": "1992962682",
    "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": "2015-01-25",
        "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": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Jan 25, 2015; 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.