NPIMap

Organization Active NPI

Mount Sinai Community Foundation Dba Sinai Medical Group

  • Multi-Specialty Clinic/Center
  • Chicago, IL
National Provider Identifier
1801239991
Registry record updated Apr 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Practice address
2653 W Ogden Ave
3Rd Floor Suite a,
Chicago, IL 60608-1647
Phone
(773) 257-6840
Fax
(773) 257-6712
NPI assigned
Apr 9, 2013
Last updated
Apr 9, 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 Apr 9, 2013

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

2653 W Ogden Ave
3Rd Floor Suite a,
Chicago, IL 60608-1647

Mailing address

3537 Paysphere Cir
Chicago, IL 60674-0035
Phone (708) 786-2900

Other names 1

  • SMG at SCI-Medicine Other name

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
Mount Sinai Medical Gro53 organizations share this tax ID, including this one
Part of
Mount Sinai Medical Gro

Organizations with this tax ID in the same state 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1801239991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740035",
            "telephone_number": "708-786-2900",
            "fax_number": "708-786-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2653 W OGDEN AVE",
            "address_2": "3RD FLOOR SUITE A,",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081647",
            "telephone_number": "773-257-6840",
            "fax_number": "773-257-6712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT SINAI COMMUNITY FOUNDATION",
        "enumeration_date": "2013-04-09",
        "last_updated": "2013-04-09",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMG at SCI-Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Apr 9, 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.