NPIMap

Organization Active NPI

Great Heights Otp

  • Methadone Clinic
  • Calumet City, IL
National Provider Identifier
1720516099
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
GREAT HEIGHTS OTP
Practice address
1473 Ring Rd
Calumet City, IL 60409-5459
Phone
(708) 862-8156
NPI assigned
May 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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

Authorized official

Name
Dr. Adeyemi Fatoki, MDNPI 1760449938
Title
Medical Director
Phone
(708) 862-8156

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

1473 Ring Rd
Calumet City, IL 60409-5459

Mailing address

1473 Ring Rd
Calumet City, IL 60409-5459
Phone (708) 862-8156

Other practice location 1

315 E McKinley Rd
Ottawa, IL 61350-4805
Phone (815) 434-0228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200306001226 IL Part B Supplier - Opioid Treatment Program (Otp) 4284062191 1 other NPI on this enrollment
Practice locations: Calumet City, IL; Ottawa, IL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Great Heights Otp2 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

1473 Ring Rd
Calumet City, IL 60409
Phone (708) 862-8156

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1720516099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1473 RING RD",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095459",
            "telephone_number": "708-862-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1473 RING RD",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095459",
            "telephone_number": "708-862-8156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 E McKinley Rd",
            "address_purpose": "LOCATION",
            "city": "Ottawa",
            "state": "IL",
            "postal_code": "613504805",
            "country_code": "US",
            "telephone_number": "815-434-0228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT HEIGHTS OTP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "FATOKI",
        "authorized_official_first_name": "ADEYEMI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "708-862-8156",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.