Chestnut Health Systems, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CHESTNUT HEALTH SYSTEMS, INC

Practice address

12 N 64TH St
Belleville, IL 62223-3809

Phone

(618) 397-0900

Fax

(618) 397-0093

NPI assigned

Dec 21, 2016

Last updated

Jan 30, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dietra Kulicke

Title

Executive Director of CFHC

Phone

(309) 557-1437

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Chestnut Health Systems Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bloomington, IL
  • NPI 1366431686

  O20040603000738

  Same enrollment
• Chestnut Health Systems Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wood River, IL
  • NPI 1235941311

  O20040603000738

  Same enrollment

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

{
    "created_epoch": "1482278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1831634237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429",
            "telephone_number": "309-827-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 N 64TH ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622233809",
            "telephone_number": "618-397-0900",
            "fax_number": "618-397-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-21",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "KULICKE",
        "authorized_official_first_name": "DIETRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF CFHC",
        "authorized_official_telephone_number": "309-557-1437"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabha Shoukat Cheema, MD
• Chesntut Health Systems, Inc.
• Chestnut Health Systems Inc
• Chestnut Health Systems Inc
• Chestnut Health Systems Inc. (Chestnut Family Health Center)
• Chestnut Health Systems, Inc.
• Chestnut Health Systems, Inc.
• Child's Play Therapy, LLC
• Children's Home and Aid
• Childrens Medical Associates,LTD.

• Primary Care Clinic/Center in Belleville, IL
• Providers in Belleville, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.