The Board of Trustees of the University of Illinois
Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago, IL
NPI 1124787908 · NPPES record last updated Jun 27, 2025
Key facts
- NPI
- 1124787908
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
- Practice address
- 4634 S Bishop St
Chicago, IL 60609-3240 - Phone
- (312) 355-5570
- NPI assigned
- Dec 9, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
- Name
- Timothy Stecker
- Title
- Cfo
- Phone
- (312) 355-7653
Owners & managing parties with NPI records 23
Owned or controlled facilities with NPI records 10
Other NPIs with the same Medicare PAC ID 23
Corporate family (same tax ID) 23
Facilities with the same owner 10
Practitioners 1,134
-
Alexandra Leigh Aaronson, M.D.
-
Motaz Abas, MD
-
Khaled Abdelhady, M.D.
-
Rohit Abraham, MD, MPH, MAT
-
Omer Acar, MD
-
Elenmor Achurra, DNP, APRN, PMHNP-BC
-
Jessica Acosta, APRN
-
Lisa Marie Adiutori, D.O.
-
Mitra Afshari, M.D. M.P.H
-
Lorraine Aguada, NP
-
Aneet Ahluwalia, M.D.
-
Jamal Ahmad, M.D.
-
Zohair Ahmed, M.D.
-
Aleena Aickareth, APN-CNP
-
Olusola A. Ajilore, M.D.
-
Abayomi Akintorin, M.D.
-
Osama Al Deyabat, MBBS
-
Peter Alahi, MD
-
Ali Alaraj, M.D
-
Cecilia Anne Albaro, M.D.
-
Ibrahim Aldasoqi, APN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Federally qualified health center certification: CCN 781067
- Legal name
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
- Doing business as
- UI HEALTH MILE SQUARE HEALTH CENTER BACK OF THE YARDS DENTAL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 3, 2022
- Last certification
- May 3, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Government · Non-profit
- Incorporated
- Feb 1, 2022 in IL
- Enrollment address
- 4634 S Bishop St
Chicago, IL 60609-3240
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| John Bolden |
Corporate Director |
Jan 1, 2010 | 100% |
| Carol Gyimatey |
Corporate Director |
Jan 16, 2018 | 100% |
| Gloria Riley |
Corporate Director |
Jan 1, 2005 | 100% |
| Beverly Echols |
Corporate Director |
Aug 1, 2012 | 100% |
| Dennis Harezlak |
Corporate Director |
May 1, 2020 | 100% |
| Richard Boykin |
Corporate Director |
Jan 16, 2018 | 100% |
| Clarence Long |
Corporate Director |
Jan 1, 2013 | 100% |
| Jeanette Moore |
Corporate Director |
Jan 1, 2004 | 100% |
| Carl Malone |
Corporate Director |
Jan 1, 2004 | 100% |
| The Board of Trustees of the University of Illinois |
5% Or Greater Indirect Ownership Interest | Feb 1, 2022 | 100% |
| Paul Ellinger |
Corporate Director |
Aug 1, 2021 | 100% |
| Timothy Stecker |
Corporate Officer |
Oct 24, 2024 | 100% |
| W-2 Managing Employee |
May 1, 2018 | 100% | |
| Elizabeth Duarte |
Corporate Director |
May 1, 2020 | 100% |
| Randall Harris |
Corporate Director |
Jan 1, 2003 | 100% |
| Mattie Williams |
Corporate Director |
Jan 1, 2005 | 100% |
| Martha Valdez |
Corporate Officer |
Jan 16, 2014 | 100% |
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| University of Illinois Hospital and Clinics |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| University of Illinois Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| Uimcc MSHC at South Shore |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2012 |
| Uic Mile Square Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 2, 2012 |
| Mile Square Back of the Yards |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Apr 10, 2008 |
| Uic-Mile Square at Cicero |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Nov 10, 2010 |
| University of Illinois - Mile Square Health Center Englewood |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Jul 2, 2012 |
| Mile Square Davis Health and Wellness Center |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Oct 1, 2015 |
| The Board of Trustees of the University of Illinois |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) Operational/Managerial Control (100%) |
May 9, 2020 May 9, 2020 |
| Ui Health Mile Square Health Center Primary and Immediate Care Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220711002856 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 3072422716 | Practice locations: Chicago, IL |
National Provider Directory
- Tax ID family
- Univ of Illinois Hospit
- Part of
- Univ of Illinois Hospit
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
4634 S Bishop St
Chicago, IL 60609-3240
Mailing address
1220 S Wood St
Chicago, IL 60608-1202
Phone (312) 413-3282
Other names
- UI Health Mile Square Health Center Back of the Yards Dental
Other providers in Chicago, IL
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
All providers in Chicago, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.