NPIMap

Organization Active NPI

Mount Sinai Community Foudation

Doing business as Holy Cross Physician Pavillion

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1104242718
Registry record updated Mar 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MOUNT SINAI COMMUNITY FOUDATION
Doing business as
Holy Cross Physician Pavillion
Practice address
2701 W 68TH St
Chicago, IL 60629-1813
Phone
(773) 884-7920
NPI assigned
Mar 7, 2014
Last updated
Mar 7, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNT SINAI COMMUNITY FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2014

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

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 1

  • Holy Cross Physician Pavillion Doing business as

Medicare participation

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

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 43

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

View all 43

National Provider Directory

National Provider Directory
Tax ID family
Mount Sinai Medical Gro53 organizations share this tax ID, including this one
Part of
Mount Sinai Medical Gro

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394150400000",
    "number": "1104242718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26460 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731264",
            "telephone_number": "773-257-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 W 68TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606291813",
            "telephone_number": "773-884-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SINAI COMMUNITY FOUDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT SINAI COMMUNITY FOUNDATION",
        "enumeration_date": "2014-03-07",
        "last_updated": "2014-03-07",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "773-257-6850",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holy Cross Physician Pavillion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 7, 2014; 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.