NPIMap

Organization Active NPI

Health Department

  • Community Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1447418017
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
036048048 Issued in IL
Legal business name
HEALTH DEPARTMENT
Practice address
5400 S Hyde Park Blvd Apt D2
Chicago, IL 60615-5852
Phone
(773) 667-4631
NPI assigned
May 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Authorized official

Name
Mrs. Prathibha V Tharimala, MD
Title
Pediatrician
Phone
(773) 667-4631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 036048048 IL Primary

Addresses

Primary practice location

5400 S Hyde Park Blvd Apt D2
Chicago, IL 60615-5852

Mailing address

5400 S Hyde Park Blvd Apt D2
Chicago, IL 60615-5852
Phone (773) 667-4631

Other identifiers 1

IdentifierTypeStateIssuer
U45703MedicaidIL

Other names 1

  • St Bernard Hospital Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1447418017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 S HYDE PARK BLVD APT D2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155852",
            "telephone_number": "773-667-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 S HYDE PARK BLVD APT D2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155852",
            "telephone_number": "773-667-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "THARIMALA",
        "authorized_official_first_name": "PRATHIBHA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "773-667-4631",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "IL",
            "license": "036048048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "U45703",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Bernard Hospital",
            "code": "4",
            "type": "Former Legal Business 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 May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.