NPIMap

Organization Active NPI

Vascular Access Centers of Illinois at Morgan Park, LLC

  • Ambulatory Surgical Clinic/Center
  • Chicago, IL
National Provider Identifier
1689163875
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC
Practice address
1701 W Monterey Ave
Chicago, IL 60643-4257
Phone
(773) 366-8035
Fax
(773) 881-1214
NPI assigned
May 3, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Authorized official

Name
Amitabha MitraNPI 1811976954
Title
President
Phone
(312) 654-2720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1701 W Monterey Ave
Chicago, IL 60643-4257

Mailing address

210 S Des Plaines St
Chicago, IL 60661-5500
Phone (312) 654-2721

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191018000013 IL Part B Supplier - Ambulatory Surgical Center 0143551440 Practice locations: Chicago, IL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Vascular Access Center of Il at Morgan Park LLCCCN 14C0001183
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1701 W Monterey Ave
Ste 7B
Chicago, IL 60643
Phone (773) 366-8035

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1689163875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S DES PLAINES ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606615500",
            "telephone_number": "312-654-2721",
            "fax_number": "866-954-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W MONTEREY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434257",
            "telephone_number": "773-366-8035",
            "fax_number": "773-881-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-03",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "MITRA",
        "authorized_official_first_name": "AMITABHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-654-2720"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "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 Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.