NPIMap

Organization Active NPI

The Board of Trustees of the University of Illinois

Doing business as Mile Square-IHC Thresholds South

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1598879819
Registry record updated Aug 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
Mile Square-IHC Thresholds South
Practice address
734 W 47TH St
Chicago, IL 60609-4411
Phone
(312) 996-9354
Fax
(312) 996-7725
NPI assigned
Aug 17, 2006
Last updated
Aug 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2008

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

Authorized official

Name
William R. Nicholas, PHD
Title
Executive Director Uic Medical Plan
Phone
(312) 413-0573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

734 W 47TH St
Chicago, IL 60609-4411

Mailing address

734 W 47TH St
Chicago, IL 60609-4411
Phone (312) 996-9354

Other identifiers 2

IdentifierTypeStateIssuer
01634874OtherILBC/BS
14-1072OtherILMEDICARE CERTIFICATION

Other names 1

  • Mile Square-IHC Thresholds South 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

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1598879819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606094411",
            "telephone_number": "312-996-9354",
            "fax_number": "312-996-7725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "734 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606094411",
            "telephone_number": "312-996-9354",
            "fax_number": "312-996-7725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR UIC MEDICAL PLAN",
        "authorized_official_telephone_number": "312-413-0573",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "01634874",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CERTIFICATION",
            "identifier": "14-1072",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile Square-IHC Thresholds South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; 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.