NPIMap

Organization Active NPI

Carver Military Academy

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1053622043
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARVER MILITARY ACADEMY
Practice address
13100 S Doty Ave
Chicago, IL 60827-1597
Phone
(773) 535-5357
Fax
(773) 995-7985
NPI assigned
Jun 24, 2010
Organization subpart
Yes
Parent organization
TCA HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Authorized official

Name
Veronica Clarke
Title
Ceo
Phone
(773) 928-5090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

13100 S Doty Ave
Chicago, IL 60827-1597

Mailing address

1029 E 130TH St
Chicago, IL 60628-6908
Phone (773) 995-6300

Other names 1

  • TCA Health, Inc NFP Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0956481Carver Military Academy School Based Health Ctr13100 S Doty Ave, Chicago, IL 60827Certificate of waiverDec 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Clinic in Altgeld Inc7 organizations share this tax ID, including this one
Part of
Clinic in Altgeld Inc

Other organizations with this tax ID 6

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

Locations

13100 S Doty Ave
Chicago, IL 60827
Phone (773) 535-5357

NPI Registry JSON

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1053622043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 E 130TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606286908",
            "telephone_number": "773-995-6300",
            "fax_number": "773-995-7985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13100 S DOTY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "608271597",
            "telephone_number": "773-535-5357",
            "fax_number": "773-995-7985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARVER MILITARY ACADEMY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TCA HEALTH, INC.",
        "enumeration_date": "2010-06-24",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-928-5090"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCA Health, Inc NFP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TCA Health, Inc NFP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.