NPIMap

Organization Active NPI

Rush University Medical Center

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1902873003
Registry record updated Aug 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RUSH UNIVERSITY MEDICAL CENTER
Practice address
1645 W Jackson Blvd
Suite 215
Chicago, IL 60612-3276
Phone
(312) 942-8000
NPI assigned
Mar 7, 2006
Organization subpart
Yes
Parent organization
RUSH UNIVERSITY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2013

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

Authorized official

Name
Brian T Smith
Title
VP/Authorized Official
Phone
(312) 942-6909

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

1645 W Jackson Blvd
Suite 215
Chicago, IL 60612-3276

Mailing address

1645 W Jackson Blvd
Suite 215
Chicago, IL 60612-3276
Phone (312) 942-8000

Other names 1

  • Lifetime Medical Associates Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0961008Lifetime Medical Associates1645 W Jackson, Ste 215, Chicago, IL 60612Provider-performed microscopyJun 30, 2027

National Provider Directory

National Provider Directory
Part of
University Anesthesiologists SC

Locations

1645 W Jackson Blvd
Ste 215
Chicago, IL 60612
Phone (312) 942-3254

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376006400000",
    "number": "1902873003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD",
            "address_2": "SUITE 215",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123276",
            "telephone_number": "312-942-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W JACKSON BLVD",
            "address_2": "SUITE 215",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123276",
            "telephone_number": "312-942-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSH UNIVERSITY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUSH UNIVERSITY MEDICAL CENTER",
        "enumeration_date": "2006-03-07",
        "last_updated": "2013-08-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "312-942-6909"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime Medical Associates",
            "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 Aug 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.