Active NPI
Cook County
Doing business as Central Campus Specialty Care Clinic (FFS)
- Family Medicine Physician
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- COOK COUNTY
- Doing business as
- Central Campus Specialty Care Clinic (FFS)
- Practice address
- 1901 W Harrison St
Chicago, IL 60612-3714 - Phone
- (312) 864-6126
- NPI assigned
- Jan 29, 2020
- Last updated
- Mar 2, 2020
- Organization subpart
- Yes
- Parent organization
- COOK COUNTY
NPPES NPI Registry
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 Operations
- Phone
- (312) 864-4649
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NU | Primary |
Addresses
Primary practice location
1901 W Harrison St
Chicago, IL 60612-3714
Mailing address
1900 W Polk St RM 220C
Chicago, IL 60612-3723
Other names 1
- Central Campus Specialty Care Clinic (FFS)
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101228000196 | IL | Part A Provider - Hospital | 2860398088 |
26 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Arlington Heights, IL; Robbins, IL; North Riverside, IL; Ford Heights, IL; Cicero, IL; Chicago, IL; Blue Island, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1790316784. Details of each certification follow.
Hospital certification: CCN 140124
- Legal name
- COOK COUNTY
- Doing business as
- JOHN H. STROGER, JR HOSPITAL OF COOK COUNTY
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Mar 12, 2016
- Beds
- 918
- Ownership / control type
- Local
- Organization structure
- Government
- Incorporated
- Jan 1, 1866 in IL
- Enrollment address
- 1901 W Harrison St
Chicago, IL 60612-3714 - Hospital subgroups
- General, Acute care, Other
Other NPIs on the same Medicare enrollment 26
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Cook County Health at Blue Island Health Center
- Clinic Pharmacy
- Blue Island, IL
- NPI 1043238298
O20101228000196
-
dba Robbins Health Center (FFS)
- Family Medicine Physician
- Robbins, IL
- NPI 1053942045
O20101228000196
-
dba Cook County Health - S - UA
- Multi-Specialty Clinic/Center
- Chicago, IL
- NPI 1093283533
O20101228000196
-
dba Cook County Health at North Riverside Health (FFS)
- Family Medicine Physician
- North Riverside, IL
- NPI 1295366466
O20101228000196
-
dba Woody Winston Health Center
- Primary Care Clinic/Center
- Phoenix, IL
- NPI 1336269133
O20101228000196
-
dba Ruth M. Rothstein CORE Center (FFS)
- Family Medicine Physician
- Chicago, IL
- NPI 1366073256
O20101228000196
-
dba Arlington Heights Health Center (FFS)
- Family Medicine Physician
- Arlington Heights, IL
- NPI 1366073355
O20101228000196
-
dba Cook County Health Professional Building
- Multi-Specialty Clinic/Center
- Chicago, IL
- NPI 1386110674
O20101228000196
-
dba Near South Health Cener
- Primary Care Clinic/Center
- Chicago, IL
- NPI 1396865077
O20101228000196
-
dba Cottage Grove Health Center (FFS)
- Family Medicine Physician
- Ford Heights, IL
- NPI 1427689413
O20101228000196
-
dba Oak Forest Health Center (FFS)
- Family Medicine Physician
- Oak Forest, IL
- NPI 1457982340
O20101228000196
-
dba Morton East Adolescent Health Center (FFS)
- Family Medicine Physician
- Cicero, IL
- NPI 1457982449
O20101228000196
Care Compare: Hospital
Medicare Care Compare- Listed as
- John H Stroger Jr Hospital
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Tax ID family
- Community Triage Center
- 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/Behavioral Health Agency
- Chicago, IL
- NPI 1922549294
-
- Public Health or Welfare Agency
- Chicago, IL
- NPI 1700051448
-
dba Cook County Health at Blue Island
- Family Medicine Physician
- Blue Island, IL
- NPI 1700400744
-
dba Children's Advocacy Center (FFS)
- Family Medicine Physician
- Chicago, IL
- NPI 1740811736
-
dba Logan Square Health Center (FFS)
- Family Medicine Physician
- Chicago, IL
- NPI 1750912648
-
dba John H. Stroger, Jr. Hospital BC Outpatient Pharmacy
- Institutional Pharmacy
- Chicago, IL
- NPI 1770892135
-
dba Cook County Health at Blue Island
- Geriatric Medicine (Family Medicine) Physician
- Blue Island, IL
- NPI 1780205708
-
dba John H. Stroger, Jr. Hospital of Cook County
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1821278938
-
dba Provident Dialysis Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1831846922
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Eze Peter Nwaezeigwe | Corporate Director | Nov 13, 2018 | |
| W-2 Managing Employee | Nov 13, 2018 | ||
| Cook County | 5% Or Greater Direct Ownership Interest | Oct 27, 2010 | 100% |
| Scott Spencer | Corporate Officer | Dec 29, 2025 |
Owners & managing parties with NPI records 4
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Provident Hospital of Cook County
- General Acute Care Hospital
- Chicago, IL
- NPI 1487664561
5% Or Greater Direct Ownership Interest
-
dba Provident Dialysis Center
- Renal Dialysis Technician
- Chicago, IL
- NPI 1578170221
5% Or Greater Direct Ownership Interest
-
dba John H. Stroger, Jr. Hospital of Cook County
- General Acute Care Hospital
- Chicago, IL
- NPI 1588612832
5% Or Greater Direct Ownership Interest
-
dba John H. Stroger, Jr. Hospital of Cook County
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1821278938
5% Or Greater Direct Ownership Interest
Practitioners & affiliated clinicians
Affiliated clinicians 673
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Hospitalist Physician
- Chicago, IL
- NPI 1154841286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580256000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1583107200000",
"number": "1790316784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 W POLK ST RM 220C",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123714",
"telephone_number": "312-864-6126"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COOK COUNTY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COOK COUNTY",
"enumeration_date": "2020-01-29",
"last_updated": "2020-03-02",
"certification_date": "2020-03-02",
"status": "A",
"authorized_official_last_name": "ANDRLE",
"authorized_official_first_name": "SCOTT",
"authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE OPERATIONS",
"authorized_official_telephone_number": "312-864-4649"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Central Campus Specialty Care Clinic (FFS)",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Central Campus Specialty Care Clinic (FFS)",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago, IL
- Cook County
- Cook County (Stroger Hospital FFS)
- Cook County (Children's Advocacy Center (FFS))
- Cook County (Logan Square Health Center (FFS))
- Cook County (John H. Stroger, Jr. Hospital BC Outpatient Pharmacy)
- Cook County (John H. Stroger, Jr. Hospital of Cook County)
- Cook County (Cook County Health & Hospitals System Physician Services)
- Cook County (Bronzeville Health Center)
- Cook County (Provident Dialysis Center)
- Cook County (Fantus Health Center Refill Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.