Provident Hospital of Cook County

Primary specialty

Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X

License

03681558 Issued in IL

Legal business name

PROVIDENT HOSPITAL OF COOK COUNTY

Practice address

500 E 51St St
Chicago, IL 60615-2400

Phone

(312) 572-2000

Fax

(312) 572-2595

NPI assigned

Jul 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mary Abraham, M.D

Title

Physician

Phone

(312) 572-2000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104842343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7517 FLORENCE AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605164482",
            "telephone_number": "630-271-1270",
            "fax_number": "630-271-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E 51ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606152400",
            "telephone_number": "312-572-2000",
            "fax_number": "312-572-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HOSPITAL OF COOK COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "312-572-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IL",
            "license": "03681558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proverbs 3 PC (That's The Tooth)
• Proverbs 3 PC (That's The Tooth)
• Tim S. Provias, M.D.
• Providence Center
• Providence Homecare Services Inc
• Provident Hospital of Cook County
• Provident Hospital of Cook County
• Provider Connection
• Provider Services at St Bernard
• Provider Stat PLLC

• Medicare Defined Swing Bed Hospital Unit in Chicago, IL
• Providers in Chicago, IL by specialty
• Medicare Defined Swing Bed Hospital Unit in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.