Active NPI
Cook County
- Clinic Pharmacy
- Chicago, IL
National Provider Identifier
1013035781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic Pharmacy
- License
- 054014914
- Legal business name
- COOK COUNTY
- Practice address
- 1901 W Harrison St
Chicago, IL 60612-3714 - Phone
- (312) 864-6189
- Fax
- (312) 864-9288
- NPI assigned
- Mar 27, 2007
- Organization subpart
- Yes
- Parent organization
- COOK COUNTY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Busker
- Title
- Assistant Director of Pharmacy
- Phone
- (312) 864-2194
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic Pharmacy | 3336C0002X | 054014914 | IL | Primary |
Addresses
Primary practice location
1901 W Harrison St
Chicago, IL 60612-3714
Mailing address
1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 864-6189
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021374 | Other | PK |
Other names 1
- FANTUS HEALTH CENTER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031209000747 | IL | Part B Supplier - Clinic/Group Practice | 2860398088 |
Receives reassigned benefits from 1,783 practitioners 29 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL; Ford Heights, IL; North Riverside, IL; Robbins, IL; Arlington Heights, IL |
Other NPIs on the same Medicare enrollment 29
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Community Triage Center
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Infectious Disease Physician
- Chicago, IL
- NPI 1083728398
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1461542400000",
"number": "1013035781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123714",
"telephone_number": "312-864-6189",
"fax_number": "312-864-9288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123714",
"telephone_number": "312-864-6189",
"fax_number": "312-864-9288"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COOK COUNTY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COOK COUNTY",
"enumeration_date": "2007-03-27",
"last_updated": "2016-04-25",
"status": "A",
"authorized_official_last_name": "BUSKER",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "ASSISTANT DIRECTOR OF PHARMACY",
"authorized_official_telephone_number": "312-864-2194"
},
"taxonomies": [
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": "IL",
"license": "054014914",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2021374",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FANTUS HEALTH CENTER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; 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.