NPIMap

Organization Active NPI

Elemental Center LTD.

  • Psychiatry Physician
  • Orland Park, IL
National Provider Identifier
1033410477
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036103889 Issued in IL
Legal business name
ELEMENTAL CENTER LTD.
Practice address
14484 John Humphrey Dr
Orland Park, IL 60462-2638
Phone
(708) 364-0580
Fax
(708) 364-0480
NPI assigned
Nov 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Dr. Martins A Adeoye, MDNPI 1962431726
Title
Ceo
Phone
(708) 364-0580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 036103889 IL Primary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0804X 036103889 IL
Federally Qualified Health Center (FQHC) 261QF0400X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

14484 John Humphrey Dr
Orland Park, IL 60462-2638

Mailing address

14484 John Humphrey Dr
Orland Park, IL 60462-2638
Phone (708) 364-0580

Other practice location 1

1431 McHenry Rd Ste 105
Buffalo Grove, IL 60089-1378
Phone (708) 364-0580

Other practice location 2

612 S Western Ave Apt 1
Chicago, IL 60612-4682
Phone (708) 364-0580

Other names 1

  • Haven Health SC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160128001830 IL Part B Supplier - Clinic/Group Practice 6305149196 Receives reassigned benefits from 16 practitioners
Practice locations: Buffalo Grove, IL; Orland Park, IL; Downers Grove, IL; Chicago, IL

National Provider Directory

National Provider Directory

Locations

2707 N Halsted St
Ste 1
Chicago, IL 60614
Phone (773) 699-4924

15010 S Ravinia Ave
Ste 15
Orland Park, IL 60462
Phone 7083640580 ext. 1040

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1033410477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14484 JOHN HUMPHREY DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604622638",
            "telephone_number": "708-364-0580",
            "fax_number": "708-364-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14484 JOHN HUMPHREY DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604622638",
            "telephone_number": "708-364-0580",
            "fax_number": "708-364-0480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1431 McHenry Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Buffalo Grove",
            "state": "IL",
            "postal_code": "600891378",
            "country_code": "US",
            "telephone_number": "708-364-0580",
            "fax_number": "708-364-0480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "612 S Western Ave Apt 1",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606124682",
            "country_code": "US",
            "telephone_number": "708-364-0580",
            "fax_number": "708-364-0480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELEMENTAL CENTER LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "ADEOYE",
        "authorized_official_first_name": "MARTINS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-364-0580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036103889",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036103889",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haven Health SC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.

Verify at the official NPI Registry.