4621 Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0023770

Legal business name

4621 CORPORATION

Doing business as

Mado Healthcare - Uptown

Practice address

4621 N Racine Ave
Chicago, IL 60640-4905

Phone

(773) 784-2300

Fax

(773) 769-4621

NPI assigned

Oct 3, 2005

Last updated

Apr 8, 2019By 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

Mr. Peter J Obrien Sr.

Title

President

Phone

(312) 787-9400

Specialties & licenses 1

Addresses

Other names 1

• MADO HEALTHCARE - UPTOWN Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871580126. Details of each certification follow.

• CCN 146191 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 146191

Legal name

4621 CORPORATION

Doing business as

MADO HEALTHCARE-UPTOWN

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Feb 8, 2019

Last certification

Nov 20, 2024

Beds

132

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Incorporated

Nov 17, 1977 in IL

Enrollment address

4621 N Racine Ave
Chicago, IL 60640-4905

Nursing home name

MADO HEALTHCARE - UPTOWN

Listed as

Mado Healthcare - UptownCCN 146191 · All quality measures

Overall star rating

1 of 5

Health inspections

3 of 5

Staffing

1 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Feb 8, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

132112.2 residents per day on average

Penalties (3 years)

2Fines totaling $123,614

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Bharat K Shah, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1316971005

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Jong Lak Jin, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1225062912

  Nursing home

  Care Compare affiliation
• Bharat K Shah, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1316971005

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554681600000",
    "number": "1871580126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE STE P2W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113541",
            "telephone_number": "312-787-9400",
            "fax_number": "312-787-9434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4621 N RACINE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404905",
            "telephone_number": "773-784-2300",
            "fax_number": "773-769-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4621 CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2019-04-08",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-787-9400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": "0023770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADO HEALTHCARE - UPTOWN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.

Verify at the official NPI Registry.