Active NPI
Cook County
Doing business as Provident Dialysis Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
National Provider Identifier
1831846922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- COOK COUNTY
- Doing business as
- Provident Dialysis Center
- Practice address
- 430 East 51St PL
Chicago, IL 60615 - Phone
- (312) 864-0200
- NPI assigned
- Mar 8, 2022
- Last updated
- Mar 16, 2022
- Organization subpart
- Yes
- Parent organization
- COOK COUNTY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Scott Andrle
- Title
- Director of Managed Care
- Phone
- (312) 864-4649
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Renal Dialysis Technician | 2472R0900X | NU | ||
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NU | Primary |
Addresses
Primary practice location
430 East 51St PL
Chicago, IL 60615
Mailing address
430 East 51St PL
Chicago, IL 60615
Other names 1
- Provident Dialysis Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210115001388 | IL | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 2860398088 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Provident Dialysis Center
- Renal Dialysis Technician
- Chicago, IL
- NPI 1578170221
O20210115001388
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- Provident Dialysis Center
- Overall star rating
- Ownership
- Non-profit
- Certified
- Apr 13, 2021
- Medicare certification status
- Active
- Dialysis stations
- 12
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
National Provider Directory
National Provider Directory- Tax ID family
- Community Triage Center
- Part of
- Community Triage Center
Organizations with this tax ID in the same state 22
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Community/Behavioral Health Agency
- Chicago, IL
- NPI 1922549294
-
- Public Health or Welfare Agency
- Chicago, IL
- NPI 1700051448
-
dba Cook County Health at Blue Island
- Family Medicine Physician
- Blue Island, IL
- NPI 1700400744
-
dba Children's Advocacy Center (FFS)
- Family Medicine Physician
- Chicago, IL
- NPI 1740811736
-
dba Logan Square Health Center (FFS)
- Family Medicine Physician
- Chicago, IL
- NPI 1750912648
-
dba John H. Stroger, Jr. Hospital BC Outpatient Pharmacy
- Institutional Pharmacy
- Chicago, IL
- NPI 1770892135
-
dba Cook County Health at Blue Island
- Geriatric Medicine (Family Medicine) Physician
- Blue Island, IL
- NPI 1780205708
-
dba Central Campus Specialty Care Clinic (FFS)
- Family Medicine Physician
- Chicago, IL
- NPI 1790316784
-
dba John H. Stroger, Jr. Hospital of Cook County
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1821278938
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646697600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1647388800000",
"number": "1831846922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 EAST 51ST PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 EAST 51ST PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60615",
"telephone_number": "312-864-0200"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COOK COUNTY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COOK COUNTY",
"enumeration_date": "2022-03-08",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A",
"authorized_official_last_name": "ANDRLE",
"authorized_official_first_name": "SCOTT",
"authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
"authorized_official_telephone_number": "312-864-4649"
},
"taxonomies": [
{
"code": "2472R0900X",
"taxonomy_group": "",
"desc": "Technician, Other, Renal Dialysis",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Provident Dialysis Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Provident Dialysis Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago, IL
- Cook County (John H. Stroger, Jr. Hospital BC Outpatient Pharmacy)
- Cook County (Central Campus Specialty Care Clinic (FFS))
- Cook County (John H. Stroger, Jr. Hospital of Cook County)
- Cook County (Cook County Health & Hospitals System Physician Services)
- Cook County (Bronzeville Health Center)
- Cook County (Fantus Health Center Refill Pharmacy)
- Cook County (Jorge Prieto Health Center)
- Cook County (Ruth M Rothstein CORE Center)
- Cook County (Harrison Square FAO)
- Cook County (Englewood Health Center (FFS))
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.