MOUNT SINAI COMMUNITY FOUNDATION (NPI# 1730632043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730632043 |
| Entity Type | Organization |
| Organization Name | MOUNT SINAI COMMUNITY FOUNDATION |
| Other Organization Name | SMG SOUTH SHORE |
| Practice Address |
8012 S Crandon Ave Chicago IL 60617-1124 |
| Practice Telephone | 7733565415 |
| Mailing Telephone | 7733565415 |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |
| Authorized Official Name | DEBORAH CAPUTO (MANAGER) |
| Authorized Official Telephone | 7732572905 |
| Is Organization Subpart | Y |
| Parent Organization Name | MOUNT SINAI COMMUNITY FOUNDATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SMG South Shore | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861024176 | Mount Sinai Community Foundation | Clinic/Center | 1414 S Fairfield, Chicago, IL 60608 | 2020-02-05 |
| 1609072313 | Mount Sinai Community Foundation | Psychiatric Hospital | 2040 W Washington Blvd, Chicago, IL 60612-2429 | 2007-06-21 |
| 1649318148 | Mount Sinai Community Foundation | Surgery | 2720 W. 15th, Chicago, IL 60608-1647 | 2007-02-05 |
| 1952449456 | Mount Sinai Community Foundation | Internal Medicine | 2901 W Touhy Ave, Chicago, IL 60645-2937 | 2007-02-05 |
| 1679611628 | Mount Sinai Community Foundation | Internal Medicine | 2720 W 15th, Chicago, IL 60608-1647 | 2007-02-02 |
| 1144383084 | Mount Sinai Community Foundation | Internal Medicine | 3111 W Armitage Ave, Chicago, IL 60647-3818 | 2006-12-19 |
| 1851454698 | Mount Sinai Community Foundation | Internal Medicine | 2218 S. Michigan Ave, Smg Lakeside Medical Center, Chicago, IL 60616-2189 | 2006-12-19 |
| 1134164841 | Mount Sinai Community Foundation | Family Medicine | 1400 E. Golf Rd, Suite 118, Des Plaines, IL 60016 | 2006-06-17 |
| 1497374805 | Mount Sinai Community Foundation | Clinic/Center | 2653 W Ogden Ave, Chicago, IL 60608-1647 | 2020-04-15 |
| 1720538572 | Mount Sinai Community Foundation | Internal Medicine | 4318 S State St, Chicago, IL 60609-3701 | 2016-10-05 |
| Street Address |
8012 S CRANDON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60617-1124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053391359 | South Shore Hospital Corporation | General Acute Care Hospital | 8012 S Crandon Ave, Finance Department, Chicago, IL 60617-1124 | 2006-01-20 |
| 1871190827 | Chicago Pain Medicine Center | Durable Medical Equipment & Medical Supplies | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2020-10-02 |
| 1174006217 | Advanced Imaging Services, LLC | Radiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2018-09-14 |
| 1649782772 | Art of Pain Co | Anesthesiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2017-10-30 |
| 1710406715 | Steven R. Greenwald Md Sc | Anesthesiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2017-09-12 |
| 1194120337 | Kathleen Powell | Registered Nurse | 8012 S Crandon Ave, Rm. 318, Chicago, IL 60617-1124 | 2014-10-30 |
| 1225479470 | South Shore Hospital Corporation | Dietitian, Registered | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2013-07-16 |
| 1689935397 | South Shore Hospital Corporation | Psychiatric Unit | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2012-05-30 |
| 1346498292 | Arpit Suresh Shah | Internal Medicine | 8012 S Crandon Ave, Suite 100, Chicago, IL 60617-1124 | 2008-09-04 |
| 1811145766 | South Shore Radiologists, S.c. | Radiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2008-09-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102921 | Manuel Lule | Physical Therapy Assistant | 9535 S Jeffery Boulevard, Chicago, IL 60617 | 2020-07-24 |
| 1083253546 | Vanaja Thotten | Internal Medicine | 8012 S.crandon Ave, Chicago, IL 60617 | 2020-01-02 |
| 1427527365 | Stony Island Dental PC | Dentist | 1600 E 93rd Street, Chicago, IL 60617 | 2018-11-21 |
| 1871060301 | Tamika Nicole Whitehead | Social Worker | 2822 East 83rd Street, Chicago, IL 60617 | 2018-11-02 |
| 1528543774 | Felicia Nwankwo | Nurse Practitioner | 2822 E 83rd Street Bradond Famiy Health Cener, Chicago, IL 60617 | 2018-10-03 |
| 1972099307 | David Phan | Optometrist | 1753 E 95th St Ste B-100, Chicago, IL 60617 | 2018-07-09 |
| 1831607340 | Pamela Evette Ewing | Counselor | 9145 S. Merrill Ave, Chicago, IL 60617 | 2018-01-18 |
| 1366976631 | Ali Mostafa Serhal | Radiology | 240 E. Huron St, Suite 1-203, Chicago, IL 60617 | 2017-04-13 |
| 1447784921 | 1915-25 95th St., LLC | Clinic/Center | 1915 E 95th St, Chicago, IL 60617 | 2017-04-12 |
| 1881140408 | Yeferson Laverde | Social Worker | 3062 East 31st, Chicago, IL 60617 | 2016-09-01 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922606193 | Thatiana Carolina Schulze Goni | Internal Medicine | 5924 N Lincoln Ave Apt 205, Chicago, IL 60659-3736 | 2020-10-11 |
| 1750995742 | Eva Bartaula | Internal Medicine | 1500 S Fairfield Ave # 3, Chicago, IL 60608-1782 | 2020-09-07 |
| 1750994513 | Ranjit Babu Jasaraj | Internal Medicine | 1500 S Fairfield Ave # F-914, Chicago, IL 60608-1782 | 2020-08-30 |
| 1871106005 | Vijay Ketan Reddy | Internal Medicine | 1500 S Fairfield Ave Dept Roomf914, Chicago, IL 60608-1782 | 2020-08-27 |
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1871119172 | Irina Komissarova | Internal Medicine | 916 S Oakley Blvd, Chicago, IL 60612-4230 | 2020-06-22 |
| 1336760719 | Arslan Zahid | Internal Medicine | 5847 S Maryland Ave, Chicago, IL 60637-1463 | 2020-04-27 |
| 1104447572 | Nirmal Desai | Internal Medicine | 5841 S Maryland Ave., M/c 7082, Chicago, IL 60637-1443 | 2020-04-27 |
| 1467072447 | Justin Edmond Sipiora | Internal Medicine | 5841 S. Maryland Ave Mc 7082, Chicago, IL 60637-1443 | 2020-04-20 |
| 1003449612 | Eoht LLC | Internal Medicine | 1718 W North Shore Ave Apt 11, Chicago, IL 60626-4030 | 2020-02-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.