Individual provider Active NPI

Benjamin Hill Tudor

  • Marriage & Family Therapist
  • Chicago, IL
National Provider Identifier
1417439621
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
77 W Washington St Ste 1500
Chicago, IL 60602-3219
Phone
(773) 980-9679
NPI assigned
Sep 4, 2018
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X NU Primary

Addresses

Primary practice location

77 W Washington St Ste 1500
Chicago, IL 60602-3219

Mailing address

77 W Washington St Ste 1500
Chicago, IL 60602-3219
Phone (773) 980-9679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240823001522 IL Practitioner - Marriage and Family Therapist 3870039886 Reassigns benefits to 1 organization
I20241001001674 MN Practitioner - Marriage and Family Therapist 3870039886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Artesian Collaborative, LLCGroup PAC ID 2365831609, 5 clinicians

Practice addresses (Care Compare)

5955 Charleston Cir
Shorewood, MN 55331-2923
Phone (773) 980-9679

77 W Washington St
Suite 1500
Chicago, IL 60602-3219
Phone (773) 980-9679

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4650MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Artesian Collaborative, LLC Marriage & Family Therapist CurrentSince Aug 9, 2024 Accepting new patients
Metropolitan Family Services Past Accepting new patients
Metropolitan Family Services Past Accepting new patients

Locations

77 W Washington St
Ste 1500
Chicago, IL 60602
Phone (773) 980-7679

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1417439621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W WASHINGTON ST STE 1500",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023219",
            "telephone_number": "773-980-9679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W WASHINGTON ST STE 1500",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023219",
            "telephone_number": "773-980-9679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUDOR",
        "first_name": "BENJAMIN",
        "middle_name": "HILL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-04",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.