NPIMap

Organization Active NPI

The Board of Trustees of the University of Illinois

Doing business as UIC Maxillofacial Prosthetics Clinic

  • Customized Equipment (DME)
  • Chicago, IL
National Provider Identifier
1659501500
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
UIC Maxillofacial Prosthetics Clinic
Practice address
811 S Paulina St
118 Dent, MC 588
Chicago, IL 60612-4353
Phone
(312) 996-6933
Fax
(312) 355-4173
NPI assigned
Jul 24, 2009
Last updated
May 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Authorized official

Name
Mr. Laurence Appel
Title
Chief Financial Officer
Phone
(312) 996-3620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X Primary

Addresses

Primary practice location

811 S Paulina St
118 Dent, MC 588
Chicago, IL 60612-4353

Mailing address

1740 W Taylor St # Mc693
Chicago, IL 60612-7232
Phone (312) 996-3620

Other names 1

  • UIC Maxillofacial Prosthetics Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other CIOX HEALTH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101111000883 IL DME Supplier - Oral Surgery - DentistDME Supplier - Other 3072422716 Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Board of Trustees of the Unive811 S Paulina St, Chicago, IL 60612-4353(312) 996-7546 Facial Prostheses|Ocular Prostheses|Somatic Prostheses Accepts assignmentParticipating since Apr 8, 2022

National Provider Directory

National Provider Directory
Tax ID family
Uic Dept of Pathology122 organizations share this tax ID, including this one

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

Ownership & related parties

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
University of Illinois Hospital and ClinicsChicago, IL, CCN 140150 Hospital Operational/Managerial Control (100%) Jul 1, 1966
University of Illinois HospitalChicago, IL, CCN 14S150 Hospital Operational/Managerial Control (100%) Jul 1, 1966
Uimcc MSHC at South ShoreChicago, IL, CCN 141028 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2012
Uic Mile Square Health CenterChicago, IL, CCN 141896 Federally qualified health center Operational/Managerial Control (100%) Jul 2, 2012
Mile Square Back of the YardsChicago, IL, CCN 141074 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Apr 10, 2008
Uic-Mile Square at CiceroCicero, IL, CCN 141161 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Nov 10, 2010
University of Illinois - Mile Square Health Center EnglewoodChicago, IL, CCN 141175 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Jul 2, 2012
Mile Square Davis Health and Wellness CenterChicago, IL, CCN 781842 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
The Board of Trustees of the University of IllinoisRockford, IL, CCN 781936 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 9, 2020
May 9, 2020
Ui Health Mile Square Health Center Primary and Immediate Care CenterChicago, IL, CCN 781070 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2022
Ui Health Mile Square Health Center Back of the Yards DentalChicago, IL, CCN 781067 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2022

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1659501500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST # MC693",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "312-996-3620",
            "fax_number": "312-996-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 S PAULINA ST",
            "address_2": "118 DENT, MC 588",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124353",
            "telephone_number": "312-996-6933",
            "fax_number": "312-355-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-24",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "APPEL",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "312-996-3620",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "CIOX HEALTH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD Emdr",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CIOX",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "UIC Maxillofacial Prosthetics Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UIC Maxillofacial Prosthetics Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.