NPIMap

Organization Active NPI

Rush Presbyterian-St Lukes Med Ctr

  • Oral and Maxillofacial Surgery Clinic/Center
  • Chicago, IL
National Provider Identifier
1609956903
Registry record updated Oct 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
RUSH PRESBYTERIAN-ST LUKES MED CTR
Practice address
1725 W Harrison St
Suite 425, Pob 1
Chicago, IL 60612-3841
Phone
(312) 563-3000
Fax
(312) 563-2514
NPI assigned
Oct 17, 2006
Organization subpart
Yes
Parent organization
RUSH UNIVERSITY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2010

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

Authorized official

Name
John W. Polley
Title
Manager
Phone
(312) 563-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X Primary

Addresses

Primary practice location

1725 W Harrison St
Suite 425, Pob 1
Chicago, IL 60612-3841

Mailing address

1725 W Harrison St
Suite 425, Pob 1
Chicago, IL 60612-3841
Phone (312) 563-3000

Other identifiers 4

IdentifierTypeStateIssuer
019018936MedicaidIL
21623004OtherILJWP-RCFC #
036079739MedicaidIL
32517OtherILAAF-RCFC #

Other names 1

  • Rush Craniofacial Center Doing business as

National Provider Directory

National Provider Directory
Part of
University Anesthesiologists SC

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1609956903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST",
            "address_2": "SUITE 425, POB 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123841",
            "telephone_number": "312-563-3000",
            "fax_number": "312-563-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST",
            "address_2": "SUITE 425, POB 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123841",
            "telephone_number": "312-563-3000",
            "fax_number": "312-563-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSH PRESBYTERIAN-ST LUKES MED CTR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUSH UNIVERSITY MEDICAL CENTER",
        "enumeration_date": "2006-10-17",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "POLLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "312-563-3000"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019018936",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JWP-RCFC #",
            "identifier": "21623004",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036079739",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAF-RCFC #",
            "identifier": "32517",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rush Craniofacial Center",
            "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 Oct 18, 2010; 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.