Great Heights Otp

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

GREAT HEIGHTS OTP

Doing business as

Great Heights OTP Ottawa

Practice address

315 E McKinley Rd
Ottawa, IL 61350-4805

Phone

(815) 434-0228

NPI assigned

Jan 6, 2017

Last updated

Dec 19, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

GREAT HEIGHTS OTPAs reported in NPPES

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

Authorized official

Name

Adeyemi Fatoki, MDNPI 1760449938

Title

Owner

Phone

(312) 952-9378

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Great Heights OTP Ottawa Doing business as
• Great Heights Family Medicine, Ottawa NTP Other name

Medicare fee-for-service enrollment

Enrolled in IL

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Great Heights Otp

  • Methadone Clinic
  • Calumet City, IL
  • NPI 1720516099

  O20200306001226

  Same enrollment

Tax ID family

Great Heights Otp2 organizations share this tax ID, including this one

Part of

Great Heights Otp

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Great Heights Otp

  • Methadone Clinic
  • Calumet City, IL
  • NPI 1720516099
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Great Heights Otp

  • Methadone Clinic
  • Calumet City, IL
  • NPI 1720516099
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adeyemi Oludare Fatoki, M.D.

  • Addiction Medicine (Preventive Medicine) Physician
  • Ottawa, IL
  • NPI 1760449938
  NPD Authorized official

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

{
    "created_epoch": "1483660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1881139418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E MCKINLEY RD",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613504805",
            "telephone_number": "815-434-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E MCKINLEY RD",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613504805",
            "telephone_number": "815-434-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT HEIGHTS OTP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT HEIGHTS OTP",
        "enumeration_date": "2017-01-06",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "FATOKI",
        "authorized_official_first_name": "ADEYEMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-952-9378",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPR",
            "identifier": "A-6548-0002-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Heights OTP Ottawa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Heights Family Medicine, Ottawa NTP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Great Heights Family Medicine, Ottawa NTP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Linda Christine Gjerde, MSO/LCSW
• Michael Lawrence Glavin, MD
• German Gonzalo, MD
• Diana Goodwine, MD
• Great Heights Medical LTD.
• Tiffany Reenae Green, RN
• Dontae Greenfield
• Robert Matthew Gretencord, D.C.
• Rodney Arthur Griffis, CRNA
• John Christian Grimm

• Methadone Clinic in Ottawa, IL
• Providers in Ottawa, IL by specialty
• Methadone Clinic in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.