NPIMap

Individual provider Active NPI

Tyla Courtney

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1841329489
Registry record updated Apr 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036074585 Issued in IL
Practice address
2875 W 19TH St
Physician Center
Chicago, IL 60623-3501
Phone
(773) 484-4425
NPI assigned
Mar 2, 2007
Last updated
Apr 29, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036074585 IL Primary

Addresses

Primary practice location

2875 W 19TH St
Physician Center
Chicago, IL 60623-3501

Mailing address

PO Box 2211
Northlake, IL 60164-0211
Phone (773) 484-4425

Other identifiers 3

IdentifierTypeStateIssuer
363749530OtherTYCO MEDICAL CLINIC
0031603374OtherBLUE CROSS BLUE SHIELD
036074585MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040929000216 IL Practitioner - Internal Medicine 2567431398 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Humboldt Park HealthGroup PAC ID 8921907072, 106 clinicians

Practice addresses (Care Compare)

1044 N Mozart St
Suite 100
Chicago, IL 60622-3644
Phone (773) 292-8200

2875 W 19TH St
Chicago, IL 60623-3501
Phone (773) 484-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tyco Medical Clinic LTD Internal Medicine CurrentSince Apr 1, 1988 Accepting new patients
Humboldt Park Health Internal Medicine CurrentSince Dec 1, 2024 Accepting new patients
Shekinah Care Center Past Accepting new patients
Saint Anthony Hospital PastSince Apr 30, 2009 Accepting new patients

Locations

1044 N Francisco Ave
Chicago, IL 60622
Phone (773) 292-8227

1044 N Mozart St
Ste 100
Chicago, IL 60622
Phone (773) 292-8300

1044 N Mozart St
Ste 500
Chicago, IL 60622
Phone (773) 292-4503

2875 W 19th St
Chicago, IL 60623
Phone (773) 484-4300

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Saint Anthony HospitalChicago, IL, CCN 140095 Hospital Corporate Director Jul 1, 2012
Saint Anthony HospitalChicago, IL, CCN 14S095 Hospital Corporate Director Jul 1, 2012

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240963200000",
    "number": "1841329489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2211",
            "city": "NORTHLAKE",
            "state": "IL",
            "postal_code": "601640211",
            "telephone_number": "773-484-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 W 19TH ST",
            "address_2": "PHYSICIAN CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233501",
            "telephone_number": "773-484-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COURTNEY",
        "first_name": "TYLA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2009-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036074585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYCO MEDICAL CLINIC",
            "identifier": "363749530",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0031603374",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036074585",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.