Active NPI
Cook County
- Primary Care Clinic/Center
- Chicago, IL
National Provider Identifier
1295855096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 0005272
- Legal business name
- COOK COUNTY
- Practice address
- 1135 W 69TH St
Chicago, IL 60621-1147 - Phone
- (773) 483-5011
- NPI assigned
- Mar 29, 2007
- Organization subpart
- Yes
- Parent organization
- COOK COUNTY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Scott Andrle
- Title
- Director of Managed Care Operations
- Phone
- (312) 864-4649
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 0005272 | IL | Primary |
Addresses
Primary practice location
1135 W 69TH St
Chicago, IL 60621-1147
Mailing address
1900 W Polk St RM 220C
Chicago, IL 60612-3723
Phone (312) 864-4649
Other names 1
- Englewood Health Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031209000747 | IL | Part B Supplier - Clinic/Group Practice | 2860398088 |
Receives reassigned benefits from 1,783 practitioners 29 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL; Ford Heights, IL; North Riverside, IL; Robbins, IL; Arlington Heights, IL |
Other NPIs on the same Medicare enrollment 29
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Community Triage Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1643068800000",
"number": "1295855096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 W POLK ST RM 220C",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123723",
"telephone_number": "312-864-4649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1135 W 69TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606211147",
"telephone_number": "773-483-5011"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COOK COUNTY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COOK COUNTY",
"enumeration_date": "2007-03-29",
"last_updated": "2022-01-25",
"certification_date": "2022-01-25",
"status": "A",
"authorized_official_last_name": "ANDRLE",
"authorized_official_first_name": "SCOTT",
"authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE OPERATIONS",
"authorized_official_telephone_number": "312-864-4649"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "IL",
"license": "0005272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Englewood Health Center",
"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 25, 2022; 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.