Active NPI
Harrison Square
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1841356516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- HARRISON SQUARE
- Doing business as
- Harrison Square
- Practice address
- 605 S Wolcott Ave, Suite 605
Chicago, IL 60612 - Phone
- (312) 864-4649
- Fax
- (312) 864-9763
- NPI assigned
- Dec 28, 2006
- 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 Operations
- Phone
- (312) 864-4649
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
605 S Wolcott Ave, Suite 605
Chicago, IL 60612
Mailing address
15900 South Cicero Ave.
Oak Forest, IL 60452-4006
Phone (708) 633-3486
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0048 | Other | IL | SNF BCBS |
| ========= | Medicaid | IL |
Other names 1
- Harrison Square
National Provider Directory
National Provider Directory- Part of
- Community Triage Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1734912000000",
"number": "1841356516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15900 SOUTH CICERO AVE.",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604524006",
"telephone_number": "708-633-3486",
"fax_number": "708-633-3449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 S WOLCOTT AVE, SUITE 605",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-864-4649",
"fax_number": "312-864-9763"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HARRISON SQUARE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COOK COUNTY",
"enumeration_date": "2006-12-28",
"last_updated": "2024-12-23",
"certification_date": "2024-12-17",
"status": "A",
"authorized_official_last_name": "ANDRLE",
"authorized_official_first_name": "SCOTT",
"authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE OPERATIONS",
"authorized_official_telephone_number": "312-864-4649"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SNF BCBS",
"identifier": "0048",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "=========",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Harrison Square",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Harrison Square",
"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 Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.