NPIMap

Organization Active NPI

Child & Adolescent Health Assoc LTD

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1346230299
Registry record updated Nov 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILD & ADOLESCENT HEALTH ASSOC LTD
Practice address
1030 N Clark St
Suite 400
Chicago, IL 60610-5467
Phone
(312) 943-6964
Fax
(312) 943-6924
NPI assigned
Oct 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2009

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

Authorized official

Name
Aleta Clark, M.D.
Title
President
Phone
(312) 943-6964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1030 N Clark St
Suite 400
Chicago, IL 60610-5467

Mailing address

PO Box 189
Matteson, IL 60443-0189
Phone (708) 747-5850

Other identifiers 1

IdentifierTypeStateIssuer
036051208MedicaidIL

National Provider Directory

National Provider Directory

Locations

1030 N Clark St
Chicago, IL 60610
Phone (312) 238-7767

Practitioners & affiliated clinicians

Practitioners 12

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": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259107200000",
    "number": "1346230299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604430189",
            "telephone_number": "708-747-5850",
            "fax_number": "708-747-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 N CLARK ST",
            "address_2": "SUITE 400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606105467",
            "telephone_number": "312-943-6964",
            "fax_number": "312-943-6924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD & ADOLESCENT HEALTH ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2009-11-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ALETA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-943-6964",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036051208",
            "state": "IL"
        }
    ],
    "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 25, 2009; 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.