SOUTH SHORE HOSPITAL CORPORATION (NPI# 1689935397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689935397 |
| Entity Type | Organization |
| Organization Name | SOUTH SHORE HOSPITAL CORPORATION |
| Practice Address |
8012 S Crandon Ave Chicago IL 60617-1124 |
| Practice Telephone | 7733565000 |
| Practice Fax Number | 7737688154 |
| Mailing Telephone | 7733565000 |
| Mailing Fax Number | 7737688154 |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2012-08-15 |
| Authorized Official Name | MR. TIMOTHY ARTHUR CAVENEY (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7733565312 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | 2065105 | IL | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 510204952001 | 05 | |
| IL | 510204952401 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053391359 | South Shore Hospital Corporation | General Acute Care Hospital | 8012 S Crandon Ave, Finance Department, Chicago, IL 60617-1124 | 2006-01-20 |
| 1225479470 | South Shore Hospital Corporation | Dietitian, Registered | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2013-07-16 |
| 1861569253 | South Shore Hospital Corporation | General Acute Care Hospital | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2006-11-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTH SHORE HOSPITAL CORPORATION | 8012 S Crandon Ave, Chicago, IL 60617-1124 |
| Street Address |
8012 S CRANDON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60617-1124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053391359 | South Shore Hospital Corporation | General Acute Care Hospital | 8012 S Crandon Ave, Finance Department, Chicago, IL 60617-1124 | 2006-01-20 |
| 1871190827 | Chicago Pain Medicine Center | Durable Medical Equipment & Medical Supplies | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2020-10-02 |
| 1174006217 | Advanced Imaging Services, LLC | Radiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2018-09-14 |
| 1649782772 | Art of Pain Co | Anesthesiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2017-10-30 |
| 1710406715 | Steven R. Greenwald Md Sc | Anesthesiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2017-09-12 |
| 1730632043 | Mount Sinai Community Foundation | Internal Medicine | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2016-08-03 |
| 1194120337 | Kathleen Powell | Registered Nurse | 8012 S Crandon Ave, Rm. 318, Chicago, IL 60617-1124 | 2014-10-30 |
| 1225479470 | South Shore Hospital Corporation | Dietitian, Registered | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2013-07-16 |
| 1346498292 | Arpit Suresh Shah | Internal Medicine | 8012 S Crandon Ave, Suite 100, Chicago, IL 60617-1124 | 2008-09-04 |
| 1811145766 | South Shore Radiologists, S.c. | Radiology | 8012 S Crandon Ave, Chicago, IL 60617-1124 | 2008-09-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102921 | Manuel Lule | Physical Therapy Assistant | 9535 S Jeffery Boulevard, Chicago, IL 60617 | 2020-07-24 |
| 1083253546 | Vanaja Thotten | Internal Medicine | 8012 S.crandon Ave, Chicago, IL 60617 | 2020-01-02 |
| 1427527365 | Stony Island Dental PC | Dentist | 1600 E 93rd Street, Chicago, IL 60617 | 2018-11-21 |
| 1871060301 | Tamika Nicole Whitehead | Social Worker | 2822 East 83rd Street, Chicago, IL 60617 | 2018-11-02 |
| 1528543774 | Felicia Nwankwo | Nurse Practitioner | 2822 E 83rd Street Bradond Famiy Health Cener, Chicago, IL 60617 | 2018-10-03 |
| 1972099307 | David Phan | Optometrist | 1753 E 95th St Ste B-100, Chicago, IL 60617 | 2018-07-09 |
| 1831607340 | Pamela Evette Ewing | Counselor | 9145 S. Merrill Ave, Chicago, IL 60617 | 2018-01-18 |
| 1366976631 | Ali Mostafa Serhal | Radiology | 240 E. Huron St, Suite 1-203, Chicago, IL 60617 | 2017-04-13 |
| 1447784921 | 1915-25 95th St., LLC | Clinic/Center | 1915 E 95th St, Chicago, IL 60617 | 2017-04-12 |
| 1881140408 | Yeferson Laverde | Social Worker | 3062 East 31st, Chicago, IL 60617 | 2016-09-01 |
| Find all providers in zip 60617 | ||||
| Taxonomy Code | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639657414 | Advocate North Side Health Network | Psychiatric Unit | 836 W Wellington Ave., Chicago, IL 60657 | 2018-08-02 |
| 1427547538 | Holy Cross Hospital | Psychiatric Unit | 2701 West 68th Street, Chicago, IL 60629 | 2018-05-03 |
| 1669704326 | Isaac Ray Center At Cermak | Psychiatric Unit | 3159 N Seminary #301, Chicago, IL 60657 | 2010-02-05 |
| 1316115223 | 394567 D North | Psychiatric Unit | 4200 North Oak Park Ave, Chicago, IL 60634-1417 | 2008-02-13 |
| 1508034414 | 395061 Med Eval | Psychiatric Unit | 4200 North Oak Park Avenue, Chicago, IL 60634-1417 | 2008-02-13 |
| 1871678334 | Kindred Thc Chicago, LLC | Psychiatric Unit | 2544 W Montrose Ave, Chicago, IL 60618 | 2006-10-25 |
| 1538114392 | Bhc Streamwood Management Services LLC | Psychiatric Unit | 2233 W Division 15th Floor, Chicago, IL 60622 | 2006-05-23 |
| 1972594877 | Norwegian American Hospital Incorporated | Psychiatric Unit | 1044 North Francisco, Chicago, IL 60622 | 2005-10-31 |
| 1497750699 | Jackson Park Hospital Foundation | Psychiatric Unit | 7531 S Stony Island Ave, Chicago, IL 60649-3954 | 2005-06-15 |
| 1912473927 | Pipeline - Weiss Memorial Hospital, LLC | Psychiatric Unit | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2018-10-17 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.