NPIMap

Organization Active NPI

Heartland Health Outreach

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1720245491
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
016 Issued in IL
Legal business name
HEARTLAND HEALTH OUTREACH
Practice address
641 W 63Rd St
Chicago, IL 60621-2032
Phone
(773) 488-4277
Fax
(773) 488-4292
NPI assigned
May 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Authorized official

Name
Heidi Nelson
Title
Controller
Phone
(773) 751-4107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 016 IL Primary

Addresses

Primary practice location

641 W 63Rd St
Chicago, IL 60621-2032

Mailing address

4750 N Sheridan Rd
#434
Chicago, IL 60640-7528
Phone (773) 751-1704

Other identifiers 2

IdentifierTypeStateIssuer
016MedicaidIL
103348OtherILDORAL DENTAL

Other names 1

  • Spang South Dental Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Heartland Alliance Health14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1720245491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 N SHERIDAN RD",
            "address_2": "#434",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407528",
            "telephone_number": "773-751-1704",
            "fax_number": "773-751-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212032",
            "telephone_number": "773-488-4277",
            "fax_number": "773-488-4292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND HEALTH OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "773-751-4107"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL",
            "identifier": "103348",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spang South Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.