NPIMap

Organization Active NPI

Sundance Methadone Treatment Center,LLC

  • Methadone Clinic
  • Chicago, IL
National Provider Identifier
1316296007
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
SUNDANCE METHADONE TREATMENT CENTER,LLC
Practice address
4545 N Broadway St
3Rd Floor
Chicago, IL 60640-5975
Phone
(773) 784-1111
Fax
(773) 784-4910
NPI assigned
Sep 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Authorized official

Name
Mr. Tony P Woodard, MA/CADCNPI 1346122611
Title
Program Director
Phone
(773) 769-4545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary
Rehabilitation Clinic/Center 261QR0400X A31350001 IL
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X A31350001 IL
Substance Use Disorder Rehabilitation Hospital Unit 276400000X A31350001 IL
Substance Abuse Rehabilitation Facility 324500000X A31350001 IL

Addresses

Primary practice location

4545 N Broadway St
3Rd Floor
Chicago, IL 60640-5975

Mailing address

4545 N Broadway St
3Rd Floor
Chicago, IL 60640-5975
Phone (773) 784-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Opioid treatment program
Medicare-enrolled since Apr 28, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200819001788 IL Part B Supplier - Opioid Treatment Program (Otp) 4183040215 Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

4545 N Broadway St
Fl 3
Chicago, IL 60640
Phone (773) 784-1111

Practitioners & affiliated clinicians

Practitioners 2

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": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1316296007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 N BROADWAY ST",
            "address_2": "3RD FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405975",
            "telephone_number": "773-784-1111",
            "fax_number": "773-784-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 N BROADWAY ST",
            "address_2": "3RD FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405975",
            "telephone_number": "773-784-1111",
            "fax_number": "773-784-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE METHADONE TREATMENT CENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "773-769-4545",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA/CADC"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IL",
            "license": "A31350001",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": "A31350001",
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "IL",
            "license": "A31350001",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A31350001",
            "primary": false
        }
    ],
    "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 Nov 16, 2021; 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.