NPIMap

Organization Active NPI

Jackson Park Hospital Foundation

  • General Acute Care Hospital
  • Chicago, IL
National Provider Identifier
1497750699
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0001115 Issued in IL
Legal business name
JACKSON PARK HOSPITAL FOUNDATION
Practice address
7531 S Stony Island Ave
Chicago, IL 60649-3954
Phone
(773) 947-7500
Fax
(773) 947-7339
NPI assigned
Jun 15, 2005
Last updated
Jan 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Mr. Merritt J. Hasbrouck
Title
President
Phone
(773) 947-7500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 0001115 IL
General Acute Care Hospital 282N00000X 0001115 IL Primary

Addresses

Primary practice location

7531 S Stony Island Ave
Chicago, IL 60649-3954

Mailing address

7531 S Stony Island Ave
Chicago, IL 60649-3954
Phone (773) 947-7500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110311000387 IL Part A Provider - Hospital 2163567843 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497750699. Details of each certification follow.

Hospital certification: CCN 140177

Legal name
JACKSON PARK HOSPITAL FOUNDATION
Doing business as
JACKSON PARK HOSPITAL AND MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 11, 2022
Beds
336
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Incorporated
Aug 3, 1960 in IL
Enrollment address
7531 S Stony Island Ave
Chicago, IL 60649-3954
Other Hospital Practice Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Jackson Park HospitalCCN 140177 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2060833Jackson Park Medical Center7531 S Stony Island - Ste 176, Chicago, IL 60649Certificate of waiverNov 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Jackson Park Hosp Cat S2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: abdulhamidkeswanit@jph.medalliesdirect.net
  • Direct secure messaging: ademolaobajuluwa@jph.medalliesdirect.net
  • Direct secure messaging: aftabkhan@jph.medalliesdirect.net
  • Direct secure messaging: ahmadshaher@jph.medalliesdirect.net
  • Direct secure messaging: akhtarparvaiz@jph.medalliesdirect.net
  • Direct secure messaging: alanpollack@jph.medalliesdirect.net
  • Direct secure messaging: allisongriffiths@jph.medalliesdirect.net
  • Direct secure messaging: amjadsafvi@jph.medalliesdirect.net
  • Direct secure messaging: andredejean@jph.medalliesdirect.net
  • Direct secure messaging: andrewallen@jph.medalliesdirect.net
  • Direct secure messaging: angelawalker@jph.medalliesdirect.net
  • Direct secure messaging: anilguiati@jph.medalliesdirect.net
  • Direct secure messaging: antoniofiumara@jph.medalliesdirect.net
  • Direct secure messaging: anujjain@jph.medalliesdirect.net
  • Direct secure messaging: arlenerichardson@jph.medalliesdirect.net
  • Direct secure messaging: ashtoshgupta@jph.medalliesdirect.net
  • Direct secure messaging: ayadajani@jph.medalliesdirect.net
  • Direct secure messaging: bangaloremurthy@jph.medalliesdirect.net
  • Direct secure messaging: barrysummers@jph.medalliesdirect.net
  • Direct secure messaging: beverlycox@jph.medalliesdirect.net

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Haroon M Olomi Individual Corporate Director Apr 1, 2004
Harshad M Mehta Individual Corporate DirectorBoard Member Jun 30, 1986
Alvin Kruse Individual Corporate Director Jan 15, 2011
James Clark Individual Corporate DirectorBoard Member Dec 13, 1996
William Op Dorsey Individual Corporate OfficerCeo Jun 19, 1998 100%
Corporate DirectorChairman Jan 18, 2011 100%
G Randall Smith Individual Corporate OfficerExecutive Vice President Nov 1, 2004
W-2 Managing Employee Apr 1, 2006
Arlene Jamelle Richardson Individual Corporate DirectorDirector Jun 17, 2022
Bangalore R Murthy Individual Corporate DirectorBoard Member Apr 1, 1996
Barry R Mandell Individual Operational/Managerial ControlVP of Special Projects Feb 1, 2023
Caryn J Carranza Individual Corporate DirectorBoard Member Jun 18, 2010
Merritt Hasbrouck Individual Corporate OfficerPresident Jul 28, 1985
Corporate Director Jan 18, 2011
W-2 Managing Employee Jan 18, 2011
Margo Brooks Pugh Individual Corporate OfficerVice President of Development Jul 28, 1985
Corporate Director Jan 18, 2011
Surrenthia R Parker Individual Corporate DirectorDirector Jun 22, 2018
Zahidur Rahman Individual Corporate DirectorDirector Jun 30, 2020
Lakshmi P Dodda Individual Corporate DirectorBoard Member Apr 1, 2000

Owners & managing parties with NPI records 8

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 136

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 136

Affiliated clinicians 58

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

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1497750699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7531 S STONY ISLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493954",
            "telephone_number": "773-947-7500",
            "fax_number": "773-947-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7531 S STONY ISLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493954",
            "telephone_number": "773-947-7500",
            "fax_number": "773-947-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PARK HOSPITAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "HASBROUCK",
        "authorized_official_first_name": "MERRITT",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-947-7500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "IL",
            "license": "0001115",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0001115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.