NPIMap

Organization Active NPI

Mount Sinai Community Foundation Dba Sinai Medical Group

Doing business as Sinia Medical Group

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1407264583
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Doing business as
Sinia Medical Group
Practice address
1859 S Blue Island Ave
Chicago, IL 60608-3012
Phone
(773) 738-3111
Fax
(773) 738-5211
NPI assigned
Aug 1, 2014
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Deb Caputo
Title
Manager
Phone
(773) 257-2905

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Obstetrics & Gynecology Physician 207V00000X NU

Addresses

Primary practice location

1859 S Blue Island Ave
Chicago, IL 60608-3012

Mailing address

26460 Network PL
Chicago, IL 60673-3012
Phone (773) 257-2500

Other names 2

  • Sinia Medical Group Doing business as
  • Sinai Convenient Care Other name

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

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
14D0877613Sinai Convenient Care1859 S Blue Island Ave, Chicago, IL 60608Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mount Sinai Medical Gro53 organizations share this tax ID, including this one
Part of
Mount Sinai Medical Gro

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

1859 S Blue Island Ave
Chicago, IL 60608
Phone (312) 666-5455

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1407264583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26460 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606733012",
            "telephone_number": "773-257-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1859 S BLUE ISLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606083012",
            "telephone_number": "773-738-3111",
            "fax_number": "773-738-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP",
        "enumeration_date": "2014-08-01",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "CAPUTO",
        "authorized_official_first_name": "DEB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-257-2905"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sinia Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sinai Convenient Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 5, 2020; 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.