NPIMap

Organization Active NPI

Mount Sinai Community Foundation

Doing business as SMG Psychiatry Holy Cross

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1790112480
Registry record updated Dec 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MOUNT SINAI COMMUNITY FOUNDATION
Doing business as
SMG Psychiatry Holy Cross
Practice address
2701 W 68TH St
Chicago, IL 60629-1813
Phone
(773) 257-6672
Fax
(773) 257-5330
NPI assigned
Sep 26, 2013
Last updated
Dec 27, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNT SINAI COMMUNITY FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 27, 2013

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

Authorized official

Name
John E Vazquez, MD
Title
Cmo
Phone
(773) 257-6850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2701 W 68TH St
Chicago, IL 60629-1813

Mailing address

26460 Network PL
Chicago, IL 60673-1264
Phone (708) 786-2905

Other names 1

  • SMG Psychiatry Holy Cross Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202001032 IL Part B Supplier - Clinic/Group Practice 5991600405 Receives reassigned benefits from 683 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cicero, IL; Oak Lawn, IL; Des Plaines, IL; Chicago, IL

Other NPIs on the same Medicare enrollment 43

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

View all 43

National Provider Directory

National Provider Directory
Tax ID family
Sinai Medical Group Sur53 organizations share this tax ID, including this one
Part of
Sinai Medical Group Sur

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388102400000",
    "number": "1790112480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26460 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731264",
            "telephone_number": "708-786-2905",
            "fax_number": "773-782-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 W 68TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606291813",
            "telephone_number": "773-257-6672",
            "fax_number": "773-257-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SINAI COMMUNITY FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT SINAI COMMUNITY FOUNDATION",
        "enumeration_date": "2013-09-26",
        "last_updated": "2013-12-27",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "773-257-6850",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMG Psychiatry Holy Cross",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.