NPIMap

Organization Active NPI

The Board of Trustees of the University of Illinois

Doing business as University of Illinois Wood Street/PCC Pharmacy

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
National Provider Identifier
1740316074
Registry record updated Jan 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
93007836 Issued in IL
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
University of Illinois Wood Street/PCC Pharmacy
Practice address
840 S Wood St
Room 163
Chicago, IL 60612-4325
Phone
(312) 996-6887
Fax
(312) 355-1916
NPI assigned
Feb 23, 2007
Last updated
Jan 25, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2017

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

Authorized official

Name
Walter K Knorr
Title
Vice President, Cfo, Comptroller
Phone
(312) 996-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 93007836 IL Primary

Addresses

Primary practice location

840 S Wood St
Room 163
Chicago, IL 60612-4325

Mailing address

840 S Wood St
Suite 345 CSB, MC 884
Chicago, IL 60612-4325
Phone (312) 355-2035

Other names 1

  • University of Illinois Wood Street/PCC Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930034766 IL DME Supplier - Pharmacy 3072422716 Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Uic Dept of Pathology122 organizations share this tax ID, including this one
Part of
Uic Dept of Pathology

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

Locations

840 S Wood St
Rm 163
Chicago, IL 60612
Phone (312) 996-1312

840 S Wood St
Ste 345
Chicago, IL 60612
Phone (312) 355-1417

840 S Wood St
Ste 345H
Chicago, IL 60612

Ownership & related parties

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
University of Illinois Hospital and ClinicsChicago, IL, CCN 140150 Hospital Operational/Managerial Control (100%) Jul 1, 1966
University of Illinois HospitalChicago, IL, CCN 14S150 Hospital Operational/Managerial Control (100%) Jul 1, 1966
Uimcc MSHC at South ShoreChicago, IL, CCN 141028 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2012
Uic Mile Square Health CenterChicago, IL, CCN 141896 Federally qualified health center Operational/Managerial Control (100%) Jul 2, 2012
Mile Square Back of the YardsChicago, IL, CCN 141074 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Apr 10, 2008
Uic-Mile Square at CiceroCicero, IL, CCN 141161 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Nov 10, 2010
University of Illinois - Mile Square Health Center EnglewoodChicago, IL, CCN 141175 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Jul 2, 2012
Mile Square Davis Health and Wellness CenterChicago, IL, CCN 781842 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
The Board of Trustees of the University of IllinoisRockford, IL, CCN 781936 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 9, 2020
May 9, 2020
Ui Health Mile Square Health Center Primary and Immediate Care CenterChicago, IL, CCN 781070 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2022
Ui Health Mile Square Health Center Back of the Yards DentalChicago, IL, CCN 781067 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2022

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485302400000",
    "number": "1740316074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "SUITE 345 CSB, MC 884",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-355-2035",
            "fax_number": "312-355-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "ROOM 163",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-996-6887",
            "fax_number": "312-355-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2007-02-23",
        "last_updated": "2017-01-25",
        "status": "A",
        "authorized_official_last_name": "KNORR",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VICE PRESIDENT, CFO, COMPTROLLER",
        "authorized_official_telephone_number": "312-996-8800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "93007836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Illinois Wood Street/PCC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.