Cook County

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

COOK COUNTY

Doing business as

Cook County Health at Blue Island

Practice address

12757 S. Western Ave
Blue Island, IL 60406

Phone

(708) 293-8400

NPI assigned

Apr 30, 2020

Last updated

Apr 30, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

COOK COUNTYAs reported in NPPES

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

Authorized official

Name

Scott Andrle

Title

Director of Managed Care

Phone

(312) 864-4649

Specialties & licenses 1

Addresses

Other names 1

• Cook County Health at Blue Island Doing business as

Tax ID family

Community Triage Center67 organizations share this tax ID, including this one

Part of

Community Triage Center

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.

• Community Triage Center

  • Community/Behavioral Health Agency
  • Chicago, IL
  • NPI 1922549294
  NPD tax ID
• Cook County

  • Public Health or Welfare Agency
  • Chicago, IL
  • NPI 1700051448
  NPD tax ID
• Cook County

  dba Cook County Health at Blue Island

  • Family Medicine Physician
  • Blue Island, IL
  • NPI 1700400744
  NPD tax ID
• Cook County

  dba Children's Advocacy Center (FFS)

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1740811736
  NPD tax ID
• Cook County

  dba Logan Square Health Center (FFS)

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1750912648
  NPD tax ID
• Cook County

  dba John H. Stroger, Jr. Hospital BC Outpatient Pharmacy

  • Institutional Pharmacy
  • Chicago, IL
  • NPI 1770892135
  NPD tax ID
• Cook County

  dba Central Campus Specialty Care Clinic (FFS)

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1790316784
  NPD tax ID
• Cook County

  dba John H. Stroger, Jr. Hospital of Cook County

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chicago, IL
  • NPI 1821278938
  NPD tax ID
• Cook County

  dba Bronzeville Health Center

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1831219450
  NPD tax ID
• Cook County

  dba Provident Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chicago, IL
  • NPI 1831846922
  NPD tax ID
• Cook County

  dba Fantus Health Center Refill Pharmacy

  • Pharmacy
  • Chicago, IL
  • NPI 1841500956
  NPD tax ID
• Cook County

  dba Englewood Health Center (FFS)

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1922639913
  NPD tax ID

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

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1780205708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W POLK ST STE 220C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12757 S. WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "60406",
            "telephone_number": "708-293-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK COUNTY",
        "enumeration_date": "2020-04-30",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "ANDRLE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "312-864-4649"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cook County Health at Blue Island",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randi Coley, CADC
• Jeanine Connolly, MD
• Cook County (Cook County Health at Blue Island Health Center)
• Cook County (Cook County Health at Blue Island)
• Cook County (Cook County Health at Blue Island)
• Cook County School Dist 130
• Kesi Alyce Cook, RN
• Judith A Corcoran
• Amada Lucia Cordova
• Core Inc.

• Geriatric Medicine (Family Medicine) Physician in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Geriatric Medicine (Family Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; 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.