COOK COUNTY (PROVIDENT HOSPITAL OF COOK COUNTY) - NPI NUMBER 1487664561

Summary

Provider Name: COOK COUNTY (PROVIDENT HOSPITAL OF COOK COUNTY)

NPI Number: 1487664561

Clasification: General Acute Care Hospital (282N00000X)

Address:
500 EAST 51ST STREET
CHICAGO, IL
ZIP 60615

Phone Number: (312) 572-1200



Detailed Information

COOK COUNTY is a general acute care hospital in Chicago, IL. The provider is an acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. The assigned NPI number for this provider is 1487664561 and is registered as an organization entity type.
The provider Is Doing Business As Provident Hospital Of Cook County.

The provider's business address is:

500 EAST 51ST STREET
CHICAGO, IL
ZIP 60615-494
Phone: (312) 572-1200
Fax: (312) 572-1294

The provider's authorized official is Robert Vais .
The authorized official title is Director Of Cost And Reimbursement and has the following contact phone number (312) 864-4665.

The enumeration date for this NPI number is 8/9/2006 and was last updated on 7/27/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 282N00000X General Acute Care Hospital 0004549 IL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 14-0300 MEDICARE ID-TYPE UNSPECIFIED IL
2 93 OTHER IL BLUE CROSS BLUE SHIELD

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1487664561 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name COOK COUNTY The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name PROVIDENT HOSPITAL OF COOK COUNTY Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 500 EAST 51ST STREET The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name CHICAGO The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name IL The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 606152494 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 3125721200 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 3125721294 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 8/9/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 7/27/2012 The date that a record was last updated or changed.
16 Authorized Official Last Name VAIS The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name ROBERT The first name of the authorized official.
18 Authorized Official Title or Position DIRECTOR OF COST AND REIMBURSEMENT The title or position of the authorized official.
19 Authorized Official Telephone Number 3128644665 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 282N00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 0004549 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 14-0300 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 1 IL
27 Other Provider Identifier 2 93 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 IL
30 Other Provider Identifier Issuer 2 BLUE CROSS BLUE SHIELD
31 Is Organization Subpart N
32 Authorized Official Name Prefix Text MR.

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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