Provider Demographics
NPI:1013941053
Name:BUMP, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BUMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2135
Mailing Address - Country:US
Mailing Address - Phone:708-346-5562
Mailing Address - Fax:708-346-2059
Practice Address - Street 1:3545 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2135
Practice Address - Country:US
Practice Address - Phone:708-346-5562
Practice Address - Fax:708-346-2059
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062686207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062686Medicaid
IL1619991361OtherGROUP NPI#
ILIL4014007OtherMEDICARE PTAN#
IL1477731685OtherGROUP NPI#
685583OtherGROUP MEDICARE#
ILIL4013007OtherMEDICARE PTAN#
ILP00713296/CK6882OtherMEDICARE RAILROAD
IL203979007OtherMEDICARE PTAN-SPI
0001619074OtherBROUP BC/BS#
ILC37990Medicare UPIN
685583OtherGROUP MEDICARE#
IL216251Medicare PIN
0001619074OtherBROUP BC/BS#
IL1619991361OtherGROUP NPI#
110059310Medicare ID - Type UnspecifiedRAILROAD
IL963711Medicare ID - Type Unspecified