NPIMap

Organization Active NPI

Near North Health Service Corporation

Doing business as Near North Health Family Health Center at Oakwood Shores

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1740166255
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEAR NORTH HEALTH SERVICE CORPORATION
Doing business as
Near North Health Family Health Center at Oakwood Shores
Practice address
3753 S Cottage Grove Ave
Chicago, IL 60653-1662
Phone
(773) 268-7600
NPI assigned
Aug 12, 2025
Last updated
Aug 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Authorized official

Name
Triste Smith
Title
Chief Executive Officer
Phone
(312) 337-1073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3753 S Cottage Grove Ave
Chicago, IL 60653-1662

Mailing address

1276 N Clybourn Ave
Chicago, IL 60610-2089
Phone (312) 337-1073

Other names 1

  • Near North Health Family Health Center at Oakwood Shores Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040423000456 IL Part B Supplier - Clinic/Group Practice 9638165749 Receives reassigned benefits from 43 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20260105000738 IL Part A Provider - Federally Qualified Health Center (FQHC) 9638165749 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740166255. Details of each certification follow.

Federally qualified health center certification: CCN C41058

Legal name
NEAR NORTH HEALTH SERVICE CORPORATION
Doing business as
NEAR NORTH HEALTH - FAMILY HEALTH CENTER AT OAKWOOD SHORES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2025
Last certification
Dec 8, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3753 S Cottage Grove Ave
Chicago, IL 60653-1662

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 11

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

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
14D2253837Near North Health - Oakwood Shores Health Center3753 S Cottage Grove Ave, Chicago, IL 60653Certificate of waiverFeb 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Near N HLTH SRV Corp11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

834 E 50th St
Chicago, IL 60615
Phone (773) 358-6767

2844 N Milwaukee Ave
Chicago, IL 60618
Phone (312) 337-1073

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Evelyn Reid Individual Corporate Director Jan 1, 2010
Triste Smith Individual Corporate Officer Nov 1, 2022
W-2 Managing Employee Nov 1, 2022
David Delgado Individual Corporate Director Jan 1, 2010
Samuel Rosa Individual Corporate Director Feb 14, 2015
Patricia Cornelius Individual Corporate Officer Aug 21, 2023
Norman Bolden Individual Corporate Director Jan 1, 2010
Clarence Burch Individual Corporate Director Jan 1, 2010
Leroy Duncan Individual Corporate Director Apr 1, 2012
Carlette Carter Individual Corporate Director May 18, 2018
Tasneem Lokhandwala Individual Corporate Director Mar 1, 2024
Kenneth Dunkin Individual Corporate Director Jan 1, 2010

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1740166255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 N CLYBOURN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606102089",
            "telephone_number": "312-337-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3753 S COTTAGE GROVE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606531662",
            "telephone_number": "773-268-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEAR NORTH HEALTH SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TRISTE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "312-337-1073"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Near North Health Family Health Center at Oakwood Shores",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.