NPIMap

Organization Active NPI

The Board of Trustees of University of Illinois

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1144093006
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
THE BOARD OF TRUSTEES OF UNIVERSITY OF ILLINOIS
Practice address
751 S Sacramento Blvd
Chicago, IL 60612-3365
Phone
(312) 413-8850
NPI assigned
Nov 2, 2023
Organization subpart
Yes
Parent organization
THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Authorized official

Name
Carolyn Dickens
Title
Interim Associate Dean
Phone
(312) 413-8850

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

751 S Sacramento Blvd
Chicago, IL 60612-3365

Mailing address

845 S Damen Ave
Chicago, IL 60612-3727
Phone (312) 413-8850

Other names 1

  • UI Health Wellness Clinic at Altus Academy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Univ of Illinois Hospit122 organizations share this tax ID, including this one
Part of
Univ of Illinois Hospit

Organizations with this tax ID in the same state 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1698883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1144093006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 S DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123727",
            "telephone_number": "312-413-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 S SACRAMENTO BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123365",
            "telephone_number": "312-413-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2023-11-02",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "INTERIM ASSOCIATE DEAN",
        "authorized_official_telephone_number": "312-413-8850"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UI Health Wellness Clinic at Altus Academy",
            "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 Nov 2, 2023; 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.