NPIMap

Organization Active NPI

Foundation for Emergency Services

Doing business as The Clinic at Walmart operated by St. Bernard Hospital

  • Primary Care Clinic/Center
  • Chicago, IL
National Provider Identifier
1992053029
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0002303 Issued in IL
Legal business name
FOUNDATION FOR EMERGENCY SERVICES
Doing business as
The Clinic at Walmart operated by St. Bernard Hospital
Practice address
8331 S Stewart Ave
Chicago, IL 60620-1728
Phone
(773) 420-1234
Fax
(773) 420-1233
NPI assigned
Aug 21, 2012
Last updated
Apr 25, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
ST BERNARD HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Authorized official

Name
Mr. Guy Richard Alton
Title
Chief Financial Officer
Phone
(773) 962-4073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0002303 IL Primary

Addresses

Primary practice location

8331 S Stewart Ave
Chicago, IL 60620-1728

Mailing address

PO Box 809616
Chicago, IL 60680-8802
Phone (773) 962-4073

Other names 1

  • The Clinic at Walmart operated by St. Bernard Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000338 IL Part B Supplier - Clinic/Group Practice 4981504198 Receives reassigned benefits from 49 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
St Bernard Emerg Physic

Practitioners & affiliated clinicians

Practitioners 78

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.

View all 78

NPI Registry JSON

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1992053029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809616",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606808802",
            "telephone_number": "773-962-4073",
            "fax_number": "773-962-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8331 S STEWART AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606201728",
            "telephone_number": "773-420-1234",
            "fax_number": "773-420-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION FOR EMERGENCY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST BERNARD HOSPITAL",
        "enumeration_date": "2012-08-21",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "ALTON",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "773-962-4073",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "0002303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Clinic at Walmart operated by St. Bernard Hospital",
            "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 Apr 25, 2013; 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.