NPIMap

Organization Active NPI

Target Clinic

  • Clinic/Center
  • Chicago, IL
National Provider Identifier
1023448644
Registry record updated Nov 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
209010998 Issued in IL
Legal business name
TARGET CLINIC
Practice address
1154 S Clark St
Chicago, IL 60605-2159
Phone
(312) 212-6300
NPI assigned
Nov 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2013

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

Authorized official

Name
Elizabeth Marie Jacobsma, APN, FNP-C
Title
Nurse Practitioner
Phone
(563) 505-3837

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 209010998 IL Primary

Addresses

Primary practice location

1154 S Clark St
Chicago, IL 60605-2159

Mailing address

4733 N Clark St
Apt 2N
Chicago, IL 60640-7555

National Provider Directory

National Provider Directory
Tax ID family
Target Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1023448644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4733 N CLARK ST",
            "address_2": "APT 2N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1154 S CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052159",
            "telephone_number": "312-212-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARGET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-19",
        "status": "A",
        "authorized_official_last_name": "JACOBSMA",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "563-505-3837",
        "authorized_official_credential": "APN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "209010998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Nov 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.