NPIMap

Organization Active NPI

Cook County

  • Primary Care Clinic/Center
  • Chicago, IL
National Provider Identifier
1689794489
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0005272 Issued in IL
Legal business name
COOK COUNTY
Practice address
5501 W. Fullerton Ave
Chicago, IL 60639
Phone
(312) 395-7400
NPI assigned
Mar 29, 2007
Organization subpart
Yes
Parent organization
COOK COUNTYAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Scott Andrle
Title
Director of Managed Care Operations
Phone
(312) 864-4649

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1029862Belmont Cragin Health Center of Cook County5501 W Fullerton Ave, Chicago, IL 60639Provider-performed microscopyAug 24, 2026

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20031209000747 IL Part B Supplier - Clinic/Group Practice 2860398088 Receives reassigned benefits from 1,783 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Ford Heights, IL; North Riverside, IL; Robbins, IL; Arlington Heights, IL

National Provider Directory

National Provider Directory
Part of
Community Triage Center

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0005272 IL Primary

Addresses

NPPES NPI Registry

Primary practice location

5501 W. Fullerton Ave
Chicago, IL 60639

Mailing address

1900 W Polk St RM 220C
Chicago, IL 60612-3723
Phone (312) 864-4649

Other names 1

NPPES NPI Registry
  • Belmont Cragin Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 25, 2022.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1689794489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W POLK ST RM 220C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123723",
            "telephone_number": "312-864-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 W. FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60639",
            "telephone_number": "312-395-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK COUNTY",
        "enumeration_date": "2007-03-29",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "ANDRLE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE OPERATIONS",
        "authorized_official_telephone_number": "312-864-4649"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "0005272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Belmont Cragin Health 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 Jan 25, 2022; 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.