NPIMap

Organization Active NPI

Thrive Health IV Clinic, P.C.

  • Multi-Specialty Clinic/Center
  • Chicago, IL
National Provider Identifier
1083314744
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
THRIVE HEALTH IV CLINIC, P.C.
Practice address
2001 N Halsted St Ste 200
Chicago, IL 60614-4365
Phone
(310) 363-8757
Fax
(310) 363-8758
NPI assigned
Mar 9, 2023
Organization subpart
Yes
Parent organization
THRIVE HEALTH IV CLINIC P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Dr. Raymond Douglas, MDNPI 1124041959
Title
President
Phone
(310) 363-8757

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2001 N Halsted St Ste 200
Chicago, IL 60614-4365

Mailing address

9675 Brighton Way Ste 410
Beverly Hills, CA 90210-5192
Phone (310) 363-8757

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230925001735 IL Part B Supplier - Clinic/Group Practice 0941668057 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Thrive Health IV Clinic PC15 organizations share this tax ID, including this one
Part of
Thrive Health IV Clinic PC

Other organizations with this tax ID 14

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

View all 14

Locations

2001 N Halsted St
Chicago, IL 60614

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1083314744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY STE 410",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105192",
            "telephone_number": "310-363-8757",
            "fax_number": "310-363-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 N HALSTED ST STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144365",
            "telephone_number": "310-363-8757",
            "fax_number": "310-363-8758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE HEALTH IV CLINIC, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THRIVE HEALTH IV CLINIC P.C.",
        "enumeration_date": "2023-03-09",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-363-8757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "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 May 11, 2023; 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.