NPIMap

Organization Active NPI

The Board of Trustees of the University of Illinois

Doing business as UIH-Mile Square Health Center at South Shore

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1760400170
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
UIH-Mile Square Health Center at South Shore
Practice address
7037 S. Stony Island
Uih-Mile Square Health Center at South Shore
Chicago, IL 60649
Phone
(773) 256-0526
Fax
(312) 413-7812
NPI assigned
Jul 17, 2006
Last updated
Jul 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OFAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Mr. Timothy Stecker
Title
Cfo
Phone
(312) 355-7653

Specialties & licenses 1

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

Addresses

Primary practice location

7037 S. Stony Island
Uih-Mile Square Health Center at South Shore
Chicago, IL 60649

Mailing address

1220 S. Wood Street
Uih-Mile Square Health Center
Chicago, IL 60608-1202
Phone (312) 413-1261

Other identifiers 1

IdentifierTypeStateIssuer
BCBS PROVIDEROtherIL1622185

Other names 1

  • UIH-Mile Square Health Center at South Shore Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051229000348 IL Part A Provider - Federally Qualified Health Center (FQHC) 3072422716 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760400170. Details of each certification follow.

Federally qualified health center certification: CCN 141028

Legal name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
UIMCC MSHC AT SOUTH SHORE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 6, 2006
Last certification
Apr 6, 2006
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
7037 S Stony Island Ave
Chicago, IL 60649-1905
Related CCNs
141896

Facilities connected through Provider of Services related, parent or unit certification numbers.

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

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
John Bolden Individual Corporate DirectorDirector-Treasurer Board Member Jan 1, 2010 100%
Carol Gyimatey Individual Corporate DirectorDirector-Board Member Jan 16, 2018 100%
Gloria Riley Individual Corporate DirectorDirector-Board Member Aug 1, 2012 100%
Beverly Echols Individual Corporate DirectorDirector-Board Member Aug 1, 2012 100%
Amelia Filgham Individual Corporate DirectorBoard Member Sep 1, 2021 100%
Dennis Harezlak Individual Corporate DirectorBoard Member May 1, 2020 100%
Richard Boykin Individual Corporate DirectorDirector-Board Member Jan 16, 2018 100%
Clarence Long Individual Corporate DirectorDirector-Board Member Jan 1, 2003 100%
Jeanette Moore Individual Corporate DirectorDirector-Board Member Jan 1, 2004 100%
Carl Malone Individual Corporate DirectorDirector-President Board Member Jan 1, 2004 100%
The Board of Trustees of the University of Illinois Organization, Chicago, IL 5% Or Greater Direct Ownership Interest Aug 1, 2012 100%
Brian Townsend Individual Corporate DirectorBoard Member Sep 1, 2021 100%
Denise Stroger Individual Corporate DirectorDirector-Board Member Jan 1, 2004 100%
Paul Ellinger Individual Corporate OfficerInterim Vice President, Chief Finan Aug 9, 2021 100%
Timothy Stecker Individual Corporate OfficerChief Financial Officer Sep 4, 2024 100%
W-2 Managing EmployeeChief Financial Officer May 1, 2018 100%
Elizabeth Duarte Individual Corporate DirectorBoard Member May 1, 2020 100%
Randall Harris Individual Corporate DirectorDirector-Vice President Board Mem Jan 1, 2003 100%
Mattie Williams Individual Corporate DirectorDirector-Secretary Board Member Jan 1, 2015 100%
Martha Valdez Individual Corporate DirectorDirector-Board Member Jan 1, 2014 100%

Owners & managing parties with NPI records 23

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 23

All facility ownership & control disclosures 10

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
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 10

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

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1760400170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 S. WOOD STREET",
            "address_2": "UIH-MILE SQUARE HEALTH CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081202",
            "telephone_number": "312-413-1261",
            "fax_number": "312-413-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7037 S. STONY ISLAND",
            "address_2": "UIH-MILE SQUARE HEALTH CENTER AT SOUTH SHORE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60649",
            "telephone_number": "773-256-0526",
            "fax_number": "312-413-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF",
        "enumeration_date": "2006-07-17",
        "last_updated": "2025-07-10",
        "certification_date": "2025-06-27",
        "status": "A",
        "authorized_official_last_name": "STECKER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "312-355-7653",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1622185",
            "identifier": "BCBS PROVIDER",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UIH-Mile Square Health Center at South Shore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.