NPIMap

Organization Active NPI

Chicago Community Medical Center

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1306851233
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CHICAGO COMMUNITY MEDICAL CENTER
Practice address
2404 East 79TH St
Chicago, IL 60649-5112
Phone
(773) 978-5900
Fax
(773) 978-7656
NPI assigned
Jul 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Prem Lata Paul, MD
Title
Treasurer
Phone
(773) 978-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X IL Primary

Addresses

Primary practice location

2404 East 79TH St
Chicago, IL 60649-5112

Mailing address

155 Harbor Point #5212
Chicago, IL 60601-7381
Phone (773) 978-5900

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306851233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 HARBOR POINT #5212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017381",
            "telephone_number": "773-978-5900",
            "fax_number": "773-978-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 EAST 79TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606495112",
            "telephone_number": "773-978-5900",
            "fax_number": "773-978-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO COMMUNITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "PREM",
        "authorized_official_middle_name": "LATA",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "773-978-5900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.