Organization Active NPI

Chicago Pediatric Clinic I

  • Clinic/Center
  • Chicago, IL
National Provider Identifier
1366631137
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CHICAGO PEDIATRIC CLINIC I
Practice address
1916 W Irving Park Road
Chicago, IL 60613
Phone
(773) 477-4900
Fax
(773) 477-4478
NPI assigned
Oct 17, 2007
Last updated
Oct 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Darlene Egues, MDNPI 1700872900
Title
President
Phone
(773) 960-2555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X IL Primary

Addresses

Primary practice location

1916 W Irving Park Road
Chicago, IL 60613

Mailing address

1916 W Irving Park Road
Chicago, IL 60613
Phone (773) 477-4900

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0993489Chicago Pediatric Clinic Corporation1916 W Irving Park Rd, Chicago, IL 60613Certificate of waiverNov 14, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1366631137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 W IRVING PARK ROAD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "773-477-4900",
            "fax_number": "773-477-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 W IRVING PARK ROAD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "773-477-4900",
            "fax_number": "773-477-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO PEDIATRIC CLINIC I",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "EGUES",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-960-2555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "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 Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.