NPIMap

Organization Active NPI

South Shore Hospital Corporation

Doing business as South Shore Hospital

  • Registered Nurse
  • Chicago, IL
National Provider Identifier
1225479470
Registry record updated Dec 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
041.147476 Issued in IL
Legal business name
SOUTH SHORE HOSPITAL CORPORATION
Doing business as
South Shore Hospital
Practice address
8012 S Crandon Ave
Chicago, IL 60617-1124
Phone
(773) 356-5200
Fax
(773) 768-8154
NPI assigned
Jul 16, 2013
Last updated
Dec 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2013

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

Authorized official

Name
Mr. Leslie M. Rogers, CHE
Title
Administrator
Phone
(773) 356-5200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164.004009 IL
Registered Nurse 163W00000X 041.147476 IL Primary

Addresses

Primary practice location

8012 S Crandon Ave
Chicago, IL 60617-1124

Mailing address

8012 S Crandon Ave
Chicago, IL 60617-1124
Phone (773) 356-5200

Other identifiers 2

IdentifierTypeStateIssuer
214641OtherILAMERICAN ASSOCIATION OF DIABETES EDUCATORS
51204952001MedicaidIL

Other names 1

  • South Shore Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
South Shore Hospital Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388448000000",
    "number": "1225479470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8012 S CRANDON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606171124",
            "telephone_number": "773-356-5200",
            "fax_number": "773-768-8154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8012 S CRANDON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606171124",
            "telephone_number": "773-356-5200",
            "fax_number": "773-768-8154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-12-31",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "773-356-5200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CHE"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.004009",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.147476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ASSOCIATION OF DIABETES EDUCATORS",
            "identifier": "214641",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51204952001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Shore Hospital",
            "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 Dec 31, 2013; 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.