NPIMap

Organization Active NPI

University of Illinois Speech and Hearing

  • Speech-Language Pathologist
  • Champaign, IL
National Provider Identifier
1497923767
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146003459 Issued in IL
Legal business name
UNIVERSITY OF ILLINOIS SPEECH AND HEARING
Practice address
2001 S Oak St
Suite B
Champaign, IL 61820-0906
Phone
(217) 333-2205
Fax
(217) 333-2206
NPI assigned
Feb 20, 2008
Organization subpart
Yes
Parent organization
UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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

Authorized official

Name
Clarion Mendes, SLPNPI 1659645513
Title
Director of Clinical Education
Phone
(217) 333-2205

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 146003459 IL Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 146008043 IL
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 146004209 IL
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 146000794 IL
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 146005525 IL

Addresses

Primary practice location

2001 S Oak St
Suite B
Champaign, IL 61820-0906

Mailing address

2001 S Oak St
Suite B
Champaign, IL 61820-0906
Phone (217) 333-2205

Other identifiers 5

IdentifierTypeStateIssuer
328742120001MedicaidIL
344384568001MedicaidIL
399620438001MedicaidIL
356589993001MedicaidIL
386640092001MedicaidIL

Other names 1

  • Speech-Language Pathology Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000158 IL Part B Supplier - Clinic/Group Practice 3072422716 Receives reassigned benefits from 2,115 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 44

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

View all 44

National Provider Directory

National Provider Directory
Tax ID family
Univ of Illinois Hospit122 organizations share this tax ID, including this one
Part of
Univ of Illinois Hospit

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

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1497923767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S OAK ST",
            "address_2": "SUITE B",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618200906",
            "telephone_number": "217-333-2205",
            "fax_number": "217-333-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S OAK ST",
            "address_2": "SUITE B",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618200906",
            "telephone_number": "217-333-2205",
            "fax_number": "217-333-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF ILLINOIS SPEECH AND HEARING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2008-02-20",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "MENDES",
        "authorized_official_first_name": "CLARION",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL EDUCATION",
        "authorized_official_telephone_number": "217-333-2205",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146003459",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146008043",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146004209",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146000794",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146005525",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328742120001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344384568001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "399620438001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356589993001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "386640092001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Speech-Language Pathology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Speech-Language Pathology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.