NPIMap

Organization Active NPI

City of Chicago

  • Community Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1194725192
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CITY OF CHICAGO
Practice address
111 W Washington St FL 4
Chicago, IL 60602-2703
Phone
(312) 747-9884
Fax
(312) 747-9447
NPI assigned
Aug 1, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Authorized official

Name
Tyanna Qualls
Title
Projects Administrator
Phone
(312) 747-2203

Specialties & licenses 1

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

Addresses

Primary practice location

111 W Washington St FL 4
Chicago, IL 60602-2703

Mailing address

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

Other names 1

  • Chicago Department of Public Health Revenue 3200 Other name

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
Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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 (25 of 90)

3637 W 59th St
Chicago, IL 60629
Phone (773) 585-9682

8028 S Kedzie Ave
Chicago, IL 60652
Phone (773) 925-4772

7313 S Kingston Ave
Chicago, IL 60649
Phone (773) 721-1996

5000 S Union Ave
Chicago, IL 60609
Phone (773) 268-7767

3100 S Sacramento Ave
Chicago, IL 60623
Phone (312) 745-0262

1052 W Waveland Ave
Chicago, IL 60613
Phone (773) 525-0003

1150 E 55th St
Chicago, IL 60615
Phone (773) 288-2636

2179 N Stave St
Chicago, IL 60647
Phone (773) 342-1211

4911 W Belmont Ave
Chicago, IL 60641
Phone (773) 736-1828

1915 S Damen Ave
Chicago, IL 60608
Phone (312) 226-5654

55 W Illinois St
Chicago, IL 60654
Phone (312) 644-1234

3421 S Calumet Ave
Chicago, IL 60616
Phone (773) 326-6234

4003 W West End Ave
Chicago, IL 60624
Phone (773) 826-2088

11035 S Homewood Ave
Chicago, IL 60643
Phone (773) 238-8256

3015 W 31st St
Chicago, IL 60623
Phone (312) 745-2441

2215 W 51st St
Chicago, IL 60609
Phone (773) 776-0751

5343 N Cumberland Ave
Chicago, IL 60656
Phone (773) 631-1269

605 W Armitage Ave
Chicago, IL 60614
Phone (773) 664-5028

1545 W Rosemont Ave
Chicago, IL 60660
Phone (773) 743-1433

259 N Columbus Dr
Chicago, IL 60601
Phone (312) 856-0272

1101 S California Ave
Chicago, IL 60612
Phone (773) 826-1731

6030 N Avondale Ave
Chicago, IL 60631
Phone (773) 631-3848

4900 W Chicago Ave
Chicago, IL 60651
Phone (773) 921-3319

3040 S Sacramento
Chicago, IL 60623
Phone (312) 745-2441

1713 S Ashland Ave
Chicago, IL 60608
Phone (312) 421-5382

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1194725192",
    "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": "111 W WASHINGTON ST FL 4",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606022703",
            "telephone_number": "312-747-9884",
            "fax_number": "312-747-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-01",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "QUALLS",
        "authorized_official_first_name": "TYANNA",
        "authorized_official_title_or_position": "PROJECTS ADMINISTRATOR",
        "authorized_official_telephone_number": "312-747-2203"
    },
    "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 Revenue 3200",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 14, 2024; 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.