NPIMap

Organization Active NPI

Dekalb Behavioral Health Foundation, Inc.

Doing business as Northwestern Medicine Ben Gordon Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Sandwich, IL
National Provider Identifier
1487015194
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
DEKALB BEHAVIORAL HEALTH FOUNDATION, INC.
Doing business as
Northwestern Medicine Ben Gordon Center
Practice address
100 S Latham St Ste 204
Dasa
Sandwich, IL 60548
Phone
(815) 786-7544
NPI assigned
Mar 9, 2016
Last updated
Jul 23, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DEKALB BEHAVIORAL HEALTH FOUNDATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

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

Authorized official

Name
Christine Zydek
Title
Director of Finace
Phone
(815) 748-2986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

100 S Latham St Ste 204
Dasa
Sandwich, IL 60548

Mailing address

PO Box 1109
Dekalb, IL 60115-7109
Phone (815) 786-7544

Other names 1

  • Northwestern Medicine Ben Gordon Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160111000872 IL Part B Supplier - Clinic/Group Practice 9436451655 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dekalb, IL; Sandwich, IL

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Dekalb Behavioral Health Foundation Inc6 organizations share this tax ID, including this one
Part of
Dekalb Behavioral Health Foundation Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 S Latham St
Ste 204
Sandwich, IL 60548
Phone (815) 786-7544

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532304000000",
    "number": "1487015194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1109",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601157109",
            "telephone_number": "815-786-7544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S LATHAM ST STE 204",
            "address_2": "DASA",
            "city": "SANDWICH",
            "state": "IL",
            "postal_code": "60548",
            "telephone_number": "815-786-7544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB BEHAVIORAL HEALTH FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEKALB BEHAVIORAL HEALTH FOUNDATION, INC.",
        "enumeration_date": "2016-03-09",
        "last_updated": "2018-07-23",
        "status": "A",
        "authorized_official_last_name": "ZYDEK",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "DIRECTOR OF FINACE",
        "authorized_official_telephone_number": "815-748-2986"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwestern Medicine Ben Gordon Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandwich, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.