NPIMap

Organization Active NPI

The Board of Trustees of the University of Illinois

Doing business as UIC DHD Family Clinic

  • Clinic/Center
  • Chicago, IL
National Provider Identifier
1801920186
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
UIC DHD Family Clinic
Practice address
1640 W. Roosevelt Rd MC 727
Chicago, IL 60608-6904
Phone
(312) 413-1871
Fax
(312) 413-1593
NPI assigned
Mar 16, 2007
Last updated
May 18, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

Name
Kailas Sanghani
Title
Director of Finance
Phone
(312) 413-1350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1640 W. Roosevelt Rd MC 727
Chicago, IL 60608-6904

Mailing address

1640 W. Roosevelt Rd MC 727
Chicago, IL 60608-6904
Phone (312) 413-1871

Other names 1

  • UIC DHD Family Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000158 IL Part B Supplier - Clinic/Group Practice 3072422716 Receives reassigned benefits from 2,115 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 44

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

View all 44

National Provider Directory

National Provider Directory
Tax ID family
U of I Opthalmology Dep122 organizations share this tax ID, including this one
Part of
U of I Opthalmology Dep

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.

View all 24

Locations

1640 W Roosevelt Rd
Rm 415
Chicago, IL 60608
Phone (312) 996-3196

1713 S Ashland Ave
Chicago, IL 60608
Phone (312) 421-5382

912 S Wood St
Ste 174N
Chicago, IL 60612

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1801920186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 W. ROOSEVELT RD MC 727",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606086904",
            "telephone_number": "312-413-1871",
            "fax_number": "312-413-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 W. ROOSEVELT RD MC 727",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606086904",
            "telephone_number": "312-413-1871",
            "fax_number": "312-413-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2007-03-16",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "SANGHANI",
        "authorized_official_first_name": "KAILAS",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "312-413-1350"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UIC DHD Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UIC DHD Family 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 18, 2022; 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.