NPIMap

Organization Active NPI

Illinois Department of Human Services

  • Psychiatric Hospital
  • Rockford, IL
National Provider Identifier
1356338198
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Practice address
4402 N Main St
Rockford, IL 61103-1278
Phone
(815) 987-7103
Fax
(815) 987-7688
NPI assigned
Oct 5, 2005
Last updated
Apr 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

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

Authorized official

Name
Mohammad Yunus
Title
Hospital Administrator
Phone
(815) 987-7778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

4402 N Main St
Rockford, IL 61103-1278

Mailing address

4402 N Main St
Rockford, IL 61103-1278
Phone (815) 987-7103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000414 IL Part B Supplier - Clinic/Group Practice 9830003920 Receives reassigned benefits from 43 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centralia, IL; Waukegan, IL; Park Forest, IL; Kankakee, IL; Hines, IL; Dwight, IL; Dixon, IL; Chicago, IL…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1356338198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611031278",
            "telephone_number": "815-987-7103",
            "fax_number": "815-987-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611031278",
            "telephone_number": "815-987-7103",
            "fax_number": "815-987-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "YUNUS",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "815-987-7778"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; 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.