Organization Active NPI

City of Chicago

  • Community Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1194717330
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CITY OF CHICAGO
Practice address
South Chicago
2938 E 89TH Street
Chicago, IL 60617
Phone
(312) 747-5285
Fax
(612) 787-6161
NPI assigned
Aug 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Matthew W. Beaudet
Title
First Deputy Commissioner
Phone
(312) 747-9889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X IL Primary

Addresses

Primary practice location

South Chicago
2938 E 89TH Street
Chicago, IL 60617

Mailing address

111 W Washington St FL 4
Chicago, IL 60602-2703
Phone (312) 747-9443

Other names 2

  • Chicago Department of Public Health Doing business as
  • City of Chicago Department of Public Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303001160 IL Part B Supplier - Clinic/Group Practice 4486540929 Receives reassigned benefits from 1 practitioner
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Locations

2938 E 89th St
Chicago, IL 60617
Phone (312) 747-5285

4314 S Cottage Grove Ave
Chicago, IL 60653
Phone (312) 747-0036

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1194717330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W WASHINGTON ST FL 4",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606022703",
            "telephone_number": "312-747-9443",
            "fax_number": "312-747-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SOUTH CHICAGO",
            "address_2": "2938 E 89TH STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60617",
            "telephone_number": "312-747-5285",
            "fax_number": "612-787-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "BEAUDET",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "FIRST DEPUTY COMMISSIONER",
        "authorized_official_telephone_number": "312-747-9889"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicago Department of Public Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "City of Chicago Department of Public Health",
            "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 Jan 9, 2025; 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.