NPIMap

Organization Active NPI

Autumn Healthcare of Illinois

  • Mental Health Counselor
  • Chicago, IL
National Provider Identifier
1679628705
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AUTUMN HEALTHCARE OF ILLINOIS
Practice address
4505 S Drexel Blvd
Chicago, IL 60653-4301
Phone
(773) 285-0550
NPI assigned
Jan 25, 2007
Last updated
Apr 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
Ms. Pamela Ann Brazelton-Sykes, MSNPI 1881215804
Title
Executive Director
Phone
(773) 420-3481

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4505 S Drexel Blvd
Chicago, IL 60653-4301

Mailing address

9449 S Kedzie Ave
Ste142
Evergreen Park, IL 60805-2325
Phone (773) 420-3481

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000202 IL Part B Supplier - Clinic/Group Practice 5991607624 Receives reassigned benefits from 3 practitioners
Practice locations: Chicago, IL; Evergreen Park, IL

National Provider Directory

National Provider Directory
Tax ID family
Autumn Healthcare of Illinois2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

6250 S Park Shore East Ct
Chicago, IL 60637
Phone (773) 955-7053

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1679628705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9449 S KEDZIE AVE",
            "address_2": "STE142",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052325",
            "telephone_number": "773-420-3481",
            "fax_number": "773-420-3597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 S DREXEL BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606534301",
            "telephone_number": "773-285-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN HEALTHCARE OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "BRAZELTON-SYKES",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-420-3481",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 23, 2025; 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.