Jackson Park Hospital Foundation
Organization Active NPI General Acute Care Hospital · Chicago, IL
NPI 1497750699 · NPPES record last updated Jan 28, 2020
Key facts
- NPI
- 1497750699
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 0001115 (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
- Organization subpart
- No
Authorized official
- Name
- Mr. Merritt J. Hasbrouck
- Title
- President
- Phone
- (773) 947-7500
Owners & managing parties with NPI records 8
-
Lakshmi Dodda, M. D.
-
Harshad M Mehta, MD
-
Bangalore Murthy, M. D.
-
Haroon Olomi, M. D.
-
Surrenthia R Parker, M. D.
-
Zahidur Rahman, M. D.
-
Caryn Carranza, MD
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Member organizations 1
Practitioners 136
-
Syed F Ali, MD
-
Paul Allegretti, D.O.
-
Andrew R Allen, PA-C
-
Jolly C Anand, MD
-
Shahid A Ansari, M.D.
-
Udochukwu O Asonye, M.D.
-
Wadah Atassi, MD
-
Ukamaka Atueyi, MD
-
Xiao-Tian Austin, MD
-
Matthew Michael Bernbeck, M.D.
-
Shelly Lynne Bledsoe, M.D.
-
Kemberly Briggs, MD
-
Sally Ann Campbell-Lee, M.D.
-
Megan Chandran, DO
-
Paramjit S. Chopra, M.D.
-
Saira Choudhry, PA-C
-
Jason Crane, D.O.
-
Joseph D'Silva, MD
-
Aya Dajani, NP
-
Nisha Dharam Dasani, M.D.
-
Milton Daugherty, MD
-
James R Diesfeld, M.D.
Affiliated clinicians 58
-
Syed F Ali, MD
-
Paul Allegretti, D.O.
-
Sherwonna Barron, APRN
-
Kemberly Briggs, MD
-
David N Butler, M.D.
-
Joseph D'Silva, MD
-
Nisha Dharam Dasani, M.D.
-
Lakshmi Dodda, M. D.
-
Joe Eggebeen, M.D.
-
Raja Singh Gill, MD
-
Allison A. Griffiths, M.D.
-
Anil K Gulati, MD
-
Minh C. Hoang, M.D.
-
Anuj Jain, M.D
-
Tanyu Jelev Jelev, M.D.
-
Atul Joshi, D.O.
-
Rajiv Kandala, M.D.
-
Kevin L. Keele, M.D.
-
Abdulhamid S Keswani, M.D.
-
Aftab A Khan, M.D.
-
Georgia D Lubben, M. D.
Medicare Care Compare: Hospital
- Listed as
- Jackson Park Hospital
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2060833 | Jackson Park Medical Center | Certificate of waiver | Nov 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
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
- Other · Non-profit
- Incorporated
- Aug 3, 1960 in IL
- Enrollment address
- 7531 S Stony Island Ave
Chicago, IL 60649-3954 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Haroon M Olomi |
Corporate Director | Apr 1, 2004 | |
| Harshad M Mehta |
Corporate Director |
Jun 30, 1986 | |
| Alvin Kruse |
Corporate Director | Jan 15, 2011 | |
| James Clark |
Corporate Director |
Dec 13, 1996 | |
| William Op Dorsey |
Corporate Officer |
Jun 19, 1998 | 100% |
| Corporate Director |
Jan 18, 2011 | 100% | |
| G Randall Smith |
Corporate Officer |
Nov 1, 2004 | |
| W-2 Managing Employee | Apr 1, 2006 | ||
| Arlene Jamelle Richardson |
Corporate Director |
Jun 17, 2022 | |
| Bangalore R Murthy |
Corporate Director |
Apr 1, 1996 | |
| Barry R Mandell |
Operational/Managerial Control |
Feb 1, 2023 | |
| Caryn J Carranza |
Corporate Director |
Jun 18, 2010 | |
| Merritt Hasbrouck |
Corporate Officer |
Jul 28, 1985 | |
| Corporate Director | Jan 18, 2011 | ||
| W-2 Managing Employee | Jan 18, 2011 | ||
| Margo Brooks Pugh |
Corporate Officer |
Jul 28, 1985 | |
| Corporate Director | Jan 18, 2011 | ||
| Surrenthia R Parker |
Corporate Director |
Jun 22, 2018 | |
| Zahidur Rahman |
Corporate Director |
Jun 30, 2020 | |
| Lakshmi P Dodda |
Corporate Director |
Apr 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110311000387 | IL | Part a Provider - Hospital | 2163567843 | Practice locations: Chicago, IL |
National Provider Directory
- Tax ID family
- Jackson Park Hosp Ultra
Interoperability endpoints
- sundervinodkumar@jph.medalliesdirect.net
- mohammedhussain@jph.medalliesdirect.net
- rajchinnappan@jph.medalliesdirect.net
- faridamigally@jph.medalliesdirect.net
- pethammuthuswamy@jph.medalliesdirect.net
- ahmadshaher@jph.medalliesdirect.net
- josephdsilva@jph.medalliesdirect.net
- nevillemordi@jph.medalliesdirect.net
- anujjain@jph.medalliesdirect.net
- diannahilson@jph.medalliesdirect.net
- jayeshmadhani@jph.medalliesdirect.net
- okechukwuokolo@jph.medalliesdirect.net
- sasmitamisra@jph.medalliesdirect.net
- minhhoang@jph.medalliesdirect.net
- jamesdiesfeld@jph.medalliesdirect.net
- aftabkhan@jph.medalliesdirect.net
- syedala@jph.medalliesdirect.net
- amjadsafvi@jph.medalliesdirect.net
- kevinkeele@jph.medalliesdirect.net
- matthewstephens@jph.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | 0001115 | IL | |
| General Acute Care Hospital | 282N00000X | 0001115 | IL | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0026 | Other | IL | BLUECROSS |
Other providers in Chicago, IL
- Jackson Cila Care Inc
- Jackson Corp
- Jackson Corp
- Jackson Park Hospital
- Jackson Park Hospital Foundation
- Jackson Park SLF, LLC
- Jackson Park Suppotive Living
- Jackson Square Skilled Nursing Aand Living
- Anais Karel Jackson-Gonzalez
- Kathryn Carly Jackson-Griffin
All providers in Chicago, IL · General Acute Care Hospital in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.