NPIMap

Organization Active NPI

Eden Health Medical of Il LTD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1083297469
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EDEN HEALTH MEDICAL OF IL LTD
Practice address
131 S Dearborn St
Chicago, IL 60603-5517
Phone
(917) 261-4414
NPI assigned
May 3, 2021
Last updated
Sep 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Authorized official

Name
Donald Wayne Jenkins, MD
Title
President
Phone
(917) 261-4414

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Internal Medicine Physician 207R00000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

131 S Dearborn St
Chicago, IL 60603-5517

Mailing address

77 Goodell St Ste 510
Buffalo, NY 14203-1258
Phone (917) 261-4414

Other practice location 1

600 W Chicago Ave # 126
Chicago, IL 60654-2801
Phone (917) 261-4414

National Provider Directory

National Provider Directory

Locations

600 W Chicago Ave
#126
Chicago, IL 60654

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1083297469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 GOODELL ST STE 510",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031258",
            "telephone_number": "917-261-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 S DEARBORN ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606035517",
            "telephone_number": "917-261-4414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 W Chicago Ave # 126",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606542801",
            "country_code": "US",
            "telephone_number": "917-261-4414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDEN HEALTH MEDICAL OF IL LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-261-4414",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Sep 13, 2024; 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.