NPIMap

Organization Active NPI

Humboldt Park Health

  • Clinic/Center
  • Chicago, IL
National Provider Identifier
1609045863
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HUMBOLDT PARK HEALTH
Practice address
1044 N Francisco Ave
Chicago, IL 60622-2743
Phone
(773) 292-8200
Fax
(773) 278-3899
NPI assigned
Feb 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

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

Authorized official

Name
Dorothy Cheryl Erins
Title
Credentialing Specialist
Phone
(269) 244-5256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 000007296 IL
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1044 N Francisco Ave
Chicago, IL 60622-2743

Mailing address

1799 Momentum PL
Lock Box 231799
Chicago, IL 60689-5317
Phone (773) 292-8200

Other identifiers 2

IdentifierTypeStateIssuer
01618185OtherILBCBS
945301OtherILGROUP

Other names 1

  • PHYSICIAN SPECIALTY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prohealth Medical Cente5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1203552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1609045863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1799 MOMENTUM PL",
            "address_2": "LOCK BOX 231799",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895317",
            "telephone_number": "773-292-8200",
            "fax_number": "773-278-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N FRANCISCO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222743",
            "telephone_number": "773-292-8200",
            "fax_number": "773-278-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT PARK HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-21",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "ERINS",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "CHERYL",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "269-244-5256"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "000007296",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01618185",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "945301",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIAN SPECIALTY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHYSICIAN SPECIALTY",
            "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 Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.