Cook County

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COOK COUNTY

Doing business as

Harrison Square FAO

Practice address

605 S Wolcott Ave, Suite 605
Chicago, IL 60612

Phone

(312) 864-4649

Fax

(312) 864-9763

NPI assigned

Dec 29, 2006

Last updated

Dec 23, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

COOK COUNTYAs reported in NPPES

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

Addresses

Other identifiers 2

Other names 1

• Harrison Square FAO Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 29

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

• Cook County

  dba Fantus Health Center Pharmacy

  • Clinic Pharmacy
  • Chicago, IL
  • NPI 1013035781

  O20031209000747

  Same enrollment
• Cook County

  dba Oak Forest Hospital

  • General Acute Care Hospital
  • Oak Forest, IL
  • NPI 1023228731

  O20031209000747

  Same enrollment
• Cook County

  dba Morton East Adolescent Health Center

  • Primary Care Clinic/Center
  • Cicero, IL
  • NPI 1104946904

  O20031209000747

  Same enrollment
• Cook County

  dba Oak Forest Hospital E Building Pharmacy

  • Mail Order Pharmacy
  • Oak Forest, IL
  • NPI 1215955802

  O20031209000747

  Same enrollment
• Cook County

  dba Central Campus Specialty Care Clinic

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1245350040

  O20031209000747

  Same enrollment
• Cook County

  dba Englewood Health Center

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1295855096

  O20031209000747

  Same enrollment
• Cook County

  dba Children's Advocacy Center

  • Health Service Clinic/Center
  • Chicago, IL
  • NPI 1336268143

  O20031209000747

  Same enrollment
• Cook County

  dba Woody Winston Health Center

  • Primary Care Clinic/Center
  • Phoenix, IL
  • NPI 1336269133

  O20031209000747

  Same enrollment
• Cook County

  dba Oak Forest Hospital FFS

  • General Acute Care Hospital
  • Oak Forest, IL
  • NPI 1346360682

  O20031209000747

  Same enrollment
• Cook County

  dba Near South Health Cener

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1396865077

  O20031209000747

  Same enrollment
• Cook County

  dba Provident Hospital FFS

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1437279676

  O20031209000747

  Same enrollment
• Cook County

  dba Woodlawn Health Center

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1497874325

  O20031209000747

  Same enrollment

Part of

Community Triage Center

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1912063439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15900 SOUTH CICERO AVENUE",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604524000",
            "telephone_number": "708-633-3400",
            "fax_number": "708-633-3407"
        },
        {
            "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": "COOK COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK COUNTY",
        "enumeration_date": "2006-12-29",
        "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": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRF BCBS",
            "identifier": "0048",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "=========",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harrison Square FAO",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Harrison Square FAO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cook County (Bronzeville Health Center)
• Cook County (Provident Dialysis Center)
• Cook County (Fantus Health Center Refill Pharmacy)
• Cook County (Jorge Prieto Health Center)
• Cook County (Ruth M Rothstein CORE Center)
• Cook County (Englewood Health Center (FFS))
• Cook County (Cook County Health Central Fill Pharmacy)
• Cook County (Dusable Adolescent Health Center)
• Cook County (John Sengstacke Health Center)
• Cook County Adult Probation

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• 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.
• 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.