NPIMap

Organization Active NPI

Mount Sinai Community Foundation

Doing business as SMG Allport Medical Clinic

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1801818570
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036045400 Issued in IL
Legal business name
MOUNT SINAI COMMUNITY FOUNDATION
Doing business as
SMG Allport Medical Clinic
Practice address
1239 W 18TH St
Chicago, IL 60608-3242
Phone
(312) 738-3111
Fax
(312) 738-5211
NPI assigned
Jul 24, 2006
Last updated
May 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036045400 IL Primary
Pediatrics Physician 208000000X 036086899 IL
Surgery Physician 208600000X 036049782 IL

Addresses

Primary practice location

1239 W 18TH St
Chicago, IL 60608-3242

Mailing address

1501 S California Ave
Chicago, IL 60608-1732
Phone (708) 786-2905

Other names 1

  • SMG Allport Medical Clinic 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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1801818570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 S CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081732",
            "telephone_number": "708-786-2905",
            "fax_number": "773-762-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 W 18TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606083242",
            "telephone_number": "312-738-3111",
            "fax_number": "312-738-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SINAI COMMUNITY FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2013-05-31",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036045400",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036086899",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036049782",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMG Allport Medical Clinic",
            "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 May 31, 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.