NPIMap

Organization Active NPI

Inner-City Muslim Action Network

Doing business as IMAN Youth and Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1437672433
Registry record updated May 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INNER-CITY MUSLIM ACTION NETWORK
Doing business as
IMAN Youth and Family Health Center
Practice address
2749 W 63Rd St
Chicago, IL 60629-2342
Phone
(773) 434-4626
Fax
(773) 303-8858
NPI assigned
Jul 21, 2017
Last updated
May 2, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2018

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

Authorized official

Name
Rami Nashashibi, PHD
Title
Executive Director
Phone
(773) 434-4626

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2749 W 63Rd St
Chicago, IL 60629-2342

Mailing address

2744 W 63Rd St
Chicago, IL 60629-2343
Phone (773) 434-4626

Other names 1

  • IMAN Youth and Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180924003333 IL Part A Provider - Federally Qualified Health Center (FQHC) 4183942212 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437672433. Details of each certification follow.

Federally qualified health center certification: CCN 781917

Legal name
INNER-CITY MUSLIM ACTION NETWORK
Doing business as
IMAN YOUTH AND FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 25, 2018
Last certification
Sep 25, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 2017 in IL
Enrollment address
2749 W 63Rd St
Chicago, IL 60629-2342

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

2749 W 63rd St
Chicago, IL 60629
Phone (773) 434-4626

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Harriet Lewis Individual Corporate DirectorSenior Director Jan 27, 2013
Sean Burke Individual Corporate DirectorDirector of Health Operations Apr 1, 2018 100%
Maysoon Haleem Individual W-2 Managing EmployeeHealth Center Manager Oct 1, 2015
Chris Carter Individual Corporate OfficerBoard Chair Jan 1, 2006
Clyde El-Amin Individual Corporate OfficerCo Board Chair Jan 1, 2003
Feroz Patel Individual Corporate OfficerBoard Tresurer Jan 1, 2014
Rami Nashasshibi Individual Corporate DirectorExecutive Director Jan 22, 1997 100%

Practitioners & affiliated clinicians

Practitioners 7

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": "1500595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525219200000",
    "number": "1437672433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2744 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606292343",
            "telephone_number": "773-434-4626",
            "fax_number": "773-776-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2749 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606292342",
            "telephone_number": "773-434-4626",
            "fax_number": "773-303-8858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER-CITY MUSLIM ACTION NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-21",
        "last_updated": "2018-05-02",
        "status": "A",
        "authorized_official_last_name": "NASHASHIBI",
        "authorized_official_first_name": "RAMI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-434-4626",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMAN Youth and Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IMAN Youth and Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.