NPIMap

Organization Active NPI

VA Chicago

  • Multi-Specialty Clinic/Center
  • Evanston, IL
National Provider Identifier
1730896747
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
VA CHICAGO
Practice address
901 Maple Ave
Evanston, IL 60202-1717
Phone
(224) 471-1812
NPI assigned
Oct 31, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Authorized official

Name
Kyran D Smith, MDNPI 1659088664
Title
Physician
Phone
(224) 471-1812

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
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

901 Maple Ave
Evanston, IL 60202-1717

Mailing address

901 Maple Ave
Evanston, IL 60202-1717
Phone (224) 471-1812

Other identifiers 1

IdentifierTypeStateIssuer
984575447MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL kyransmith123456@gmail.com Direct

National Provider Directory

National Provider Directory

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": "1667174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1730896747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MAPLE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021717",
            "telephone_number": "224-471-1812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MAPLE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021717",
            "telephone_number": "224-471-1812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VA CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KYRAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "224-471-1812",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "984575447",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kyransmith123456@gmail.com",
            "affiliation": "N",
            "endpointDescription": "none",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "901 Maple Ave",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "602021717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.