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Mount Sinai Community Foudation

Organization Active NPI Internal Medicine Physician · Chicago, IL

NPI 1104242718 · NPPES record last updated Mar 7, 2014

Key facts

NPI
1104242718
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
MOUNT SINAI COMMUNITY FOUDATION
Practice address
2701 W 68TH St
Chicago, IL 60629-1813
Phone
(773) 884-7920
NPI assigned
Mar 7, 2014
Organization subpart
Yes
Parent organization (as reported)
MOUNT SINAI COMMUNITY FOUNDATION

Authorized official

Name
John E Vazquez, MD
Title
Cmo
Phone
(773) 257-6850

Other NPIs on the same Medicare enrollment 43

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

View all 43

Corporate family (same tax ID) 16

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

Practitioners 18

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040202001032 IL Part B Supplier - Clinic/Group Practice 5991600405 Receives reassigned benefits from 683 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cicero, IL; Oak Lawn, IL; Des Plaines, IL; Chicago, IL

National Provider Directory

Tax ID family
Mount Sinai Medical Gro (53 organizations share this tax ID)
Part of
Mount Sinai Medical Gro

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes

Addresses

Primary practice location

2701 W 68TH St
Chicago, IL 60629-1813

Mailing address

26460 Network PL
Chicago, IL 60673-1264
Phone (773) 257-2905

Other names

  • Holy Cross Physician Pavillion Doing business as

Other providers in Chicago, IL

All providers in Chicago, IL · Internal Medicine Physician in Illinois

Sources for this page

Verify at the official NPI Registry.