NPIMap

Organization Active NPI

Lutheran Social Services of Illinois

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
National Provider Identifier
1063637684
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Practice address
4840 W Byron St
Chicago, IL 60641-2712
Phone
(773) 282-7800
Fax
(773) 282-2163
NPI assigned
Apr 17, 2007
Last updated
Dec 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Authorized official

Name
Mr. Mark Stutrud
Title
President
Phone
(847) 635-4600

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Nurse Practitioner 363L00000X NU
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

4840 W Byron St
Chicago, IL 60641-2712

Mailing address

1001 E Touhy Ave Ste 50
Des Plaines, IL 60018-5817
Phone (847) 635-4600

Other identifiers 1

IdentifierTypeStateIssuer
0001618748OtherILBLUE CROSS BLUE SHIELD

Other names 1

  • Portage Cragin Outpatient Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050322001114 IL Part B Supplier - Clinic/Group Practice 2163403551 Receives reassigned benefits from 37 practitioners
2 other NPIs on this enrollment
Practice locations: Chicago, IL

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

940 W Cullom Ave
Chicago, IL 60613
Phone (773) 525-9000

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1063637684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E TOUHY AVE STE 50",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600185817",
            "telephone_number": "847-635-4600",
            "fax_number": "847-297-3407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 W BYRON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412712",
            "telephone_number": "773-282-7800",
            "fax_number": "773-282-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN SOCIAL SERVICES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "STUTRUD",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-635-4600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0001618748",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portage Cragin Outpatient",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Portage Cragin Outpatient",
            "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 Dec 31, 2019; 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.