Bethel Clinic & Urgent Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BETHEL CLINIC & URGENT CARE

Practice address

1705 E Sauk TRL
Sauk Village, IL 60411-4955

Phone

(708) 506-3188

Fax

(815) 205-4821

NPI assigned

Nov 15, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Chuks B Akaeze, RN/BSNNPI 1275475170

Title

Manager

Phone

(708) 506-3188

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• BETHEL FAMILY CLINIC Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dorothy Mato Akaeze

  • Family Nurse Practitioner
  • South Holland, IL
  • NPI 1649641747
  Medicare reassignment NPD
• Chuks B Akaeze

  • Nurse Practitioner
  • Sauk Village, IL
  • NPI 1275475170
  NPD Authorized official

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708819200000",
    "number": "1346958766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E SAUK TRL",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604114955",
            "telephone_number": "708-506-3188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E SAUK TRL",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604114955",
            "telephone_number": "708-506-3188",
            "fax_number": "815-205-4821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL CLINIC & URGENT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A",
        "authorized_official_last_name": "AKAEZE",
        "authorized_official_first_name": "CHUKS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-506-3188",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN/BSN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649641747",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRACTICE NPI",
            "identifier": "1346958766",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Bethelfam.org",
            "affiliation": "N",
            "endpointDescription": "Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Practice Location",
            "address_1": "1705 E Sauk Trl",
            "city": "Sauk Village",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604114955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BETHEL FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tiffany Aboagye, PHARMD
• Chuks B Akaeze
• Francine M Anderson, LCPC
• Stephen Barrett, EMT
• Lyncoya Bates-Hanserd
• Jennifer Butler
• Charles Douglas Campbell Jr.
• Machai Jaleel Cobbs
• Community Consolidated School District 168
• Consumers Pharmacy Inc.

• Primary Care Clinic/Center in Sauk Village, IL
• Providers in Sauk Village, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.