Active NPI
Gottlieb Memorial Hospital
- Registered Dietitian
- Melrose Park, IL
National Provider Identifier
1790898674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1630768
- Legal business name
- GOTTLIEB MEMORIAL HOSPITAL
- Practice address
- 701 W North Ave
Melrose Park, IL 60160-1612 - Phone
- (708) 681-3200
- Fax
- (708) 450-5058
- NPI assigned
- Aug 16, 2006
- Last updated
- Oct 19, 2011
- Organization subpart
- Yes
- Parent organization
- GOTTLIEB MEMORIAL HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Ellyn Chin
- Title
- Vice President of Finance
- Phone
- (708) 681-3200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1630768 | IL | Primary |
Addresses
Primary practice location
701 W North Ave
Melrose Park, IL 60160-1612
Mailing address
701 W North Ave
Melrose Park, IL 60160-1612
Phone (708) 681-3200
Other names 1
- GOTTLIEB MEMORIAL DIETICIANS
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051028000728 | IL | Part B Supplier - Clinic/Group Practice | 9234156233 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Melrose Park, IL |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- General Acute Care Hospital
- Melrose Park, IL
- NPI 1831170232
O20051028000728
National Provider Directory
National Provider Directory- Part of
- Gottlieb Mem Medical SE
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1318982400000",
"number": "1790898674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 W NORTH AVE",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601601612",
"telephone_number": "708-681-3200",
"fax_number": "708-450-5058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W NORTH AVE",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601601612",
"telephone_number": "708-681-3200",
"fax_number": "708-450-5058"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOTTLIEB MEMORIAL HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GOTTLIEB MEMORIAL HOSPITAL",
"enumeration_date": "2006-08-16",
"last_updated": "2011-10-19",
"status": "A",
"authorized_official_last_name": "CHIN",
"authorized_official_first_name": "ELLYN",
"authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
"authorized_official_telephone_number": "708-681-3200",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "1630768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "GOTTLIEB MEMORIAL DIETICIANS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.