Physician Compare National (NPI:1104096940)

HEALTHCARE PROVIDER: SUDARSANA CHAKRABARTI MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104096940
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5991869190
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090203000572
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHAKRABARTI
	Individual professional last name
Provider First Name	SUDARSANA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	15750 S BELL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2D
	Group Practice or individual's line 2 address
City	HOMER GLEN
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	604918420
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140213
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SILVER CROSS HOSPITAL AND MEDICAL CENTERS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140242
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CENTRAL DUPAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140062
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PALOS COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y