NPIMap

Organization Active NPI

Cook County

  • Multi-Specialty Clinic/Center
  • Chicago, IL
National Provider Identifier
1477021913
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COOK COUNTY
Practice address
500 E 51St St
Chicago, IL 60615-2400
Phone
(312) 572-2000
NPI assigned
Nov 2, 2018
Organization subpart
Yes
Parent organization
COOK COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Scott Andrle
Title
Director of Managed Care Operations
Phone
(312) 864-4649

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

500 E 51St St
Chicago, IL 60615-2400

Mailing address

500 E 51St St
Chicago, IL 60615-2400

Other names 1

  • Cook County Health - P -UA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100216000401 IL Part A Provider - Hospital 2860398088 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL

Hospital certification: CCN 140300

Legal name
COOK COUNTY
Doing business as
PROVIDENT HOSPITAL OF COOK COUNTY
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 8, 1993
Last certification
Jul 2, 2005
Beds
222
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 1866 in IL
Enrollment address
500E 51St St
Chicago, IL 60615-2400
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Provident Hospital of ChicagoCCN 140300
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Community Triage Center67 organizations share this tax ID, including this one
Part of
Community Triage Center

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Eze Peter Nwaezeigwe Individual Corporate DirectorDirector of Finance Nov 13, 2018
W-2 Managing EmployeeAd;Director of Finance Nov 13, 2018
Cook County Organization, Chicago, IL 5% Or Greater Direct Ownership Interest Aug 17, 1993 100%
Scott Spencer Individual Corporate OfficerChief Financial Officer Dec 29, 2025
W-2 Managing EmployeeChief Financial Officer Dec 29, 2025
Michael Sumrall Individual W-2 Managing EmployeeAdministrative Analyst Jun 22, 2016

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Cook County
    • General Acute Care Hospital
    • Chicago, IL
    • NPI 1487664561

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Cook County
    • Renal Dialysis Technician
    • Chicago, IL
    • NPI 1578170221

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Cook County
    • General Acute Care Hospital
    • Chicago, IL
    • NPI 1588612832

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Cook County
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Chicago, IL
    • NPI 1821278938

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 166

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 166

NPI Registry JSON

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1477021913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E 51ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606152400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E 51ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606152400",
            "telephone_number": "312-572-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK COUNTY",
        "enumeration_date": "2018-11-02",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "ANDRLE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE OPERATIONS",
        "authorized_official_telephone_number": "312-864-4649"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cook County Health - P -UA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.