NPIMap

Organization Active NPI

Board of Trustees of the University of Illinois

Doing business as University Psychiatric Clinic

  • Psychiatry Physician
  • Rockford, IL
National Provider Identifier
1699713636
Registry record updated Sep 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
University Psychiatric Clinic
Practice address
1601 Parkview Ave
Rockford, IL 61107-1822
Phone
(815) 395-5870
NPI assigned
Jun 3, 2006
Last updated
Sep 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2007

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

Authorized official

Name
John Fitzhorn
Title
Director of Patient Accounts
Phone
(815) 395-5892

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1601 Parkview Ave
Rockford, IL 61107-1822

Mailing address

1601 Parkview Ave
S300
Rockford, IL 61107-1822
Phone (815) 395-5892

Other names 1

  • University Psychiatric Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031112000158 IL Part B Supplier - Clinic/Group Practice 3072422716 Receives reassigned benefits from 2,115 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20031201000230 IL Part B Supplier - Clinic/Group Practice 3072422716 Receives reassigned benefits from 48 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Rockford, IL

Other NPIs on the same Medicare enrollment 45

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

View all 45

National Provider Directory

National Provider Directory
Tax ID family
Univ of Illinois Emerg122 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

Practitioners & affiliated clinicians

Practitioners 1

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": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189382400000",
    "number": "1699713636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PARKVIEW AVE",
            "address_2": "S300",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071822",
            "telephone_number": "815-395-5892",
            "fax_number": "815-395-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 PARKVIEW AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071822",
            "telephone_number": "815-395-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-09-10",
        "status": "A",
        "authorized_official_last_name": "FITZHORN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "815-395-5892"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Psychiatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; 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.