The Board of Trustees of the University of Illinois
Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago, IL
NPI 1346596327 · NPPES record last updated Jun 27, 2025
Key facts
- NPI
- 1346596327
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
- Practice address
- 641 W. 63Rd St
Uih-Mile Square Health Center at Englewood
Chicago, IL 60621-2032 - Phone
- (312) 413-4070
- Fax
- (312) 413-7812
- NPI assigned
- Jul 27, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Timothy Stecker
- Title
- Cfo
- Phone
- (312) 355-7653
Owners & managing parties with NPI records 23
Owned or controlled facilities with NPI records 10
Other NPIs with the same Medicare PAC ID 23
Corporate family (same tax ID) 24
Related certifications (CCN) 1
Facilities with the same owner 10
Practitioners 1,134
-
Alexandra Leigh Aaronson, M.D.
-
Motaz Abas, MD
-
Khaled Abdelhady, M.D.
-
Rohit Abraham, MD, MPH, MAT
-
Omer Acar, MD
-
Elenmor Achurra, DNP, APRN, PMHNP-BC
-
Jessica Acosta, APRN
-
Lisa Marie Adiutori, D.O.
-
Mitra Afshari, M.D. M.P.H
-
Lorraine Aguada, NP
-
Aneet Ahluwalia, M.D.
-
Jamal Ahmad, M.D.
-
Zohair Ahmed, M.D.
-
Aleena Aickareth, APN-CNP
-
Olusola A. Ajilore, M.D.
-
Abayomi Akintorin, M.D.
-
Osama Al Deyabat, MBBS
-
Peter Alahi, MD
-
Ali Alaraj, M.D
-
Cecilia Anne Albaro, M.D.
-
Ibrahim Aldasoqi, APN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Federally qualified health center certification: CCN 141175
- Legal name
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
- Doing business as
- UNIVERSITY OF ILLINOIS - MILE SQUARE HEALTH CENTER ENGLEWOOD
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 3, 2012
- Last certification
- Dec 3, 2012
- Ownership / control type
- Non-profit – corporation
- Organization structure
- Government · Non-profit
- Enrollment address
- 641 W 63Rd St
Chicago, IL 60621-2032 - Related CCNs
- 141896
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| John Bolden |
Corporate Director |
Jan 1, 2010 | 100% |
| Carol Gyimatey |
Corporate Director |
Jan 16, 2018 | 100% |
| Gloria Riley |
Corporate Director |
Jan 1, 2005 | 100% |
| Beverly Echols |
Corporate Director |
Aug 1, 2012 | 100% |
| Amelia Filgham |
Corporate Director |
Sep 1, 2021 | 100% |
| Dennis Harezlak |
Corporate Director |
May 1, 2020 | 100% |
| Richard Boykin |
Corporate Director |
Jan 16, 2018 | 100% |
| Clarence Long |
Corporate Director |
Jan 1, 2013 | 100% |
| Jeanette Moore |
Corporate Director |
Jan 1, 2004 | 100% |
| Carl Malone |
Corporate Director |
Jan 1, 2004 | 100% |
| The Board of Trustees of the University of Illinois |
5% Or Greater Indirect Ownership Interest | Jul 2, 2012 | 100% |
| Brian Townsend |
Corporate Director |
Sep 1, 2021 | 100% |
| Paul Ellinger |
Corporate Officer |
Aug 2, 2021 | 100% |
| Timothy Stecker |
Corporate Officer |
Oct 24, 2024 | 100% |
| W-2 Managing Employee |
May 1, 2018 | 100% | |
| Elizabeth Duarte |
Corporate Director |
May 1, 2020 | 100% |
| Randall Harris |
Corporate Director |
Jan 1, 2003 | 100% |
| Mattie Williams |
Corporate Director |
Jan 1, 2005 | 100% |
| Martha Valdez |
Corporate Director |
Jan 16, 2014 | 100% |
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| University of Illinois Hospital and Clinics |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| University of Illinois Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| Uimcc MSHC at South Shore |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2012 |
| Uic Mile Square Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 2, 2012 |
| Mile Square Back of the Yards |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Apr 10, 2008 |
| Uic-Mile Square at Cicero |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Nov 10, 2010 |
| Mile Square Davis Health and Wellness Center |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Oct 1, 2015 |
| The Board of Trustees of the University of Illinois |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) Operational/Managerial Control (100%) |
May 9, 2020 May 9, 2020 |
| Ui Health Mile Square Health Center Primary and Immediate Care Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2022 |
| Ui Health Mile Square Health Center Back of the Yards Dental |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Feb 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121126000551 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 3072422716 | Practice locations: Chicago, IL |
National Provider Directory
- Tax ID family
- Univ of Illinois Hospit
Locations
641 W 63rd St
Chicago, IL 60621
Phone (312) 413-4070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | IL | Yes |
Addresses
Primary practice location
641 W. 63Rd St
Uih-Mile Square Health Center at Englewood
Chicago, IL 60621-2032
Mailing address
1220 S. Wood Street
Uih-Mile Square Health Center
Chicago, IL 60608-1202
Phone (312) 413-1261
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1622185 | Other | IL | BCBS PROVIDER |
| 1622185 | Other | IL | BLUE CROSS |
Other names
- UIH-Mile Square Health Center at Englewood
Other providers in Chicago, IL
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
All providers in Chicago, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.