Humboldt Park Health

Primary specialty

Psychiatric Hospital UnitTaxonomy code 273R00000X

License

0001727 Issued in IL

Legal business name

HUMBOLDT PARK HEALTH

Practice address

1044 N Francisco Ave
Chicago, IL 60622

Phone

(773) 292-8200

Fax

(773) 278-3899

NPI assigned

Jun 28, 2006

Last updated

Jan 27, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dorothy Cheryl Erins

Title

Credentialing Specialist

Phone

(269) 244-5256

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013944479. Details of each certification follow.

• CCN 14S206 Hospital · Details

Hospital certification: CCN 14S206

Legal name

HUMBOLDT PARK HEALTH

Organization structure

CorporationNon-profit

Incorporated

Jun 11, 1935 in IL

Enrollment address

1044 N Francisco Ave
Chicago, IL 60622-2743
Hospital Psychiatric Unit

Hospital subgroups

Psychiatric unit

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Humboldt Park Health

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1972594877

  Unit of hospital

  Provider of Services

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Humboldt Park Health

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1740417153

  8921907072

  Same PAC ID
• Humboldt Park Health

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1972594877

  8921907072

  Same PAC ID

Tax ID family

Humboldt Park Health5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Humboldt Park Health

  • Adult Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1447712245
  NPD tax ID
• Humboldt Park Health

  dba Physician Specialty

  • Clinic/Center
  • Chicago, IL
  • NPI 1609045863
  NPD tax ID
• Humboldt Park Health

  dba Prohealth Medical Center

  • Clinic/Center
  • Chicago, IL
  • NPI 1619146867
  NPD tax ID
• Humboldt Park Health Wellness Center Rehab Clinic

  • Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1134952443
  NPD tax ID

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6283/brand/1/csg/22/fhir/r4

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Ali Kutom, M.D.

  • Interventional Cardiology Physician
  • Oak Lawn, IL
  • NPI 1316912918

  Corporate Director

  CMS ownership
• John Pascual Monteverde, M.D.

  • Cardiovascular Disease Physician
  • Chicago, IL
  • NPI 1558384305

  Corporate Director

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1013944479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N FRANCISCO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222743",
            "telephone_number": "773-292-8200",
            "fax_number": "773-278-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N FRANCISCO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-292-8200",
            "fax_number": "773-278-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT PARK HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "ERINS",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "CHERYL",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "269-244-5256"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "IL",
            "license": "0001727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "14S206",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Humboldt Community Dental PC (Sonrisa Family Dental)
• Humboldt Park Counseling, PLLC
• Humboldt Park Counseling, PLLC
• Humboldt Park Counseling, PLLC
• Humboldt Park Counseling, PLLC (Rogers Park Counseling, PLLC)
• Humboldt Park Health
• Humboldt Park Health (Physician Specialty)
• Humboldt Park Health (Prohealth Medical Center)
• Humboldt Park Health
• Humboldt Park Health

• Psychiatric Hospital Unit in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric Hospital Unit in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.