NPIMap

Organization Active NPI

SMG South State Health Center

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1366787012
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SMG SOUTH STATE HEALTH CENTER
Practice address
5050 S State St
Chicago, IL 60609-5302
Phone
(773) 257-1110
NPI assigned
Dec 6, 2012
Last updated
Dec 6, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MT SINAI COMMUNITY FOUNDATION DBA SINIA MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
David Berkey
Title
Vice President Physician Services
Phone
(773) 257-2664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5050 S State St
Chicago, IL 60609-5302

Mailing address

5050 S State St
Chicago, IL 60609-5302
Phone (773) 257-1110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202001032 IL Part B Supplier - Clinic/Group Practice 5991600405 Receives reassigned benefits from 683 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cicero, IL; Oak Lawn, IL; Des Plaines, IL; Chicago, IL

Other NPIs on the same Medicare enrollment 43

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

View all 43

National Provider Directory

National Provider Directory
Tax ID family
Sinai Medical Group Sur53 organizations share this tax ID, including this one
Part of
Sinai Medical Group Sur

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5050 S State St
Chicago, IL 60609
Phone (773) 257-1110

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1366787012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606095302",
            "telephone_number": "773-257-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606095302",
            "telephone_number": "773-257-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMG SOUTH STATE HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MT SINAI COMMUNITY FOUNDATION DBA SINIA MEDICAL GROUP",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "BERKEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VICE  PRESIDENT  PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "773-257-2664"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "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 Dec 6, 2012; 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.