BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS (NPI# 1881821445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881821445 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS |
| Other Organization Name | DEPT OF SURGERY |
| Practice Address |
840 S Wood St Mc 958 Chicago IL 60612-4325 |
| Mailing Address |
135 S Lasalle St Dept 3449 Chicago IL 60674-0001 |
| Practice Telephone | 3129969336 |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-06-22 |
| Authorized Official Name | DR. WILLIAM R. NICHOLAS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3124131350 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | Y |
| Parent Organization Name | DEPT OF SURGERY-CHS-WEISS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians | ||
| N | 204F00000X | Transplant Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
Allopathic & Osteopathic Physicians | ||
| N | 2082S0105X |
Plastic Surgery Specialization: Surgery of the Hand |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0105X |
Surgery Specialization: Surgery of the Hand |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0127X |
Surgery Specialization: Trauma Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
IL | Allopathic & Osteopathic Physicians | |
| N | 208C00000X | Colon & Rectal Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE GROUP | 932760 | 01 |
| IL | RAILROAD GROUP | CA8300 | 01 |
| IL | BCBS GROUP | 01618613 | 01 |
| IL | TRICARE GROUP | 004 | 01 |
| Other Name | Type Code |
|---|---|
| Dept of Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720555147 | Board of Trustees of The University of Illinois | Case Management | 3014 W 39th Pl, Chicago, IL 60632-2402 | 2018-10-24 |
| 1447390125 | Board of Trustees of The University of Illinois | Pharmacy | 722 W Maxwell St, Room 205 Mc 184, Chicago, IL 60607-5002 | 2007-02-08 |
| 1790704484 | Board of Trustees of The University of Illinois | Clinic/Center | 1059 W 13th St, Chicago, IL 60608-1526 | 2006-07-19 |
| 1467425322 | Board of Trustees of The University of Illinois | Internal Medicine | Medical Service Plan, One Illini Dr, Peoria, IL 61656 | 2006-02-10 |
| 1790252047 | Board of Trustees of The University of Illinois | Case Management | 55 W Cermak Rd, Chicago, IL 60616-2001 | 2018-10-25 |
| 1295202554 | Board of Trustees of The University of Illinois | Case Management | 1628 W Washington Blvd, Chicago, IL 60612-2613 | 2018-10-25 |
| 1972070225 | Board of Trustees of The University of Illinois | Case Management | 2641 S Calumet Ave, Chicago, IL 60616-2901 | 2018-10-25 |
| 1720554264 | Board of Trustees of The University of Illinois | Case Management | 1220 S Wood St, Chicago, IL 60608-1202 | 2018-10-23 |
| 1770059156 | Board of Trustees of The University of Illinois | Case Management | 8131 S May St, Chicago, IL 60620-3007 | 2018-10-23 |
| 1558837922 | Board of Trustees of The University of Illinois | Case Management | 641 W 63rd St, Chicago, IL 60621-2032 | 2018-10-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | 809 S Marshfield Ave Rm214, Chicago, IL 60612-4305 |
| System for Award Management (SAM) Entities | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS, THE | 364 Henry Administration Bldg, Urbana, IL 61801 |
| Street Address |
840 S WOOD ST MC 958 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-4325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457354656 | Frederick G. Behm | Pathology | 840 S Wood St, Department of Pathology, Mc847, Chicago, IL 60612-4325 | 2005-05-23 |
| 1467065581 | Monica Joan Gingell | Nurse Practitioner | 840 S Wood St, Chicago, IL 60612-4325 | 2020-08-28 |
| 1003435926 | Kyle Corso Mork | Pharmacist | 840 S Wood St, Chicago, IL 60612-4325 | 2020-04-10 |
| 1841828282 | Hovig Chelebian | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2020-03-31 |
| 1417585787 | Mehul Gilani | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2020-03-31 |
| 1730736356 | Alice Zalan | Genetic Counselor, MS | 840 S Wood St, Chicago, IL 60612-4325 | 2019-08-19 |
| 1972155547 | Lenika De Simone | Genetic Counselor, MS | 840 S Wood St, Chicago, IL 60612-4325 | 2019-07-12 |
| 1528629961 | Melissa Duckett | Nurse Practitioner | 840 S Wood St, Chicago, IL 60612-4325 | 2019-06-26 |
| 1629631098 | Jonathan Alverio | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2019-04-20 |
| 1225598766 | Daphne Porat | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2019-03-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1568080174 | Nastaran Ordoyo Haghani Rad | Student in an Organized Health Care Education/Training Program | 1950 W. Polk Street, Room 6203, Chicago, IL 60612 | 2020-07-09 |
| 1669090403 | Marianne Gagnon-konamna | Student in an Organized Health Care Education/Training Program | 1950 West Polk Street, Chicago, IL 60612 | 2020-07-08 |
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1124643028 | Ashley Swan | Dentist | 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 | 2020-06-16 |
| 1831711381 | Baillie Anne Bronner | Obstetrics & Gynecology | 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 | 2020-05-07 |
| 1154942449 | Keisha Davell Cole | Case Manager/Care Coordinator | 612 S Western Ave Unit 1, Chicago, IL 60612 | 2020-04-28 |
| 1275153777 | Isac Lim | Student in an Organized Health Care Education/Training Program | 1234 S. Wells, Chicago, IL 60612 | 2020-04-24 |
| 1578183414 | Zachary Belden | Student in an Organized Health Care Education/Training Program | Uic Psychiatry Residency 912 S. Wood St., Rm 130b Npi-s (mc 913), Chicago, IL 60612 | 2020-04-21 |
| 1548880560 | Christina Nunez | Student in an Organized Health Care Education/Training Program | 801 S. Paulina Street, M/c 850, Chicago, IL 60612 | 2020-04-20 |
| Find all providers in zip 60612 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376167809 | Francesco Bajani | Surgery | 664 N Dearborn St Apt 2f, Chicago, IL 60654-3848 | 2020-06-01 |
| 1972123099 | Andrea Liu | Surgery | 5841 S Maryland Ave Mc6040, Chicago, IL 60637-1443 | 2020-04-18 |
| 1750917183 | Alberto Maria Fratti | Surgery | 901 S Ashland Ave Apt 711, Chicago, IL 60607-4088 | 2020-03-17 |
| 1316421324 | Erica Lester | Surgery | John H Stroger, 1969 Ogden Ave, Chicago, IL 60612 | 2018-09-17 |
| 1376047381 | Richard Lawrence Nelson | Surgery | 1603 W. Taylor St., Room 983, Chicago, IL 60612-4394 | 2018-03-23 |
| 1700380029 | Alicia Roston | Surgery | 1900 W Polk St Fl 4, Chicago, IL 60612 | 2018-03-21 |
| 1982127114 | Oana Andreea Raicu | Surgery | 836 W Wellington Ave Dept Of, Chicago, IL 60657-5147 | 2017-07-19 |
| 1952824302 | Raquel Gonzalez Heredia | Surgery | 1500 South Fairfield Ave, Chicago, IL 60608 | 2017-07-18 |
| 1598287039 | Isaac Lee Hanson | Surgery | 1500 S. Fairfield Ave., Chicago, IL 60608 | 2017-07-15 |
| 1669994364 | Lucretia Nicoleta Ghidanac | Surgery | 3714 N Hermitage Ave, Chicago, IL 60613-3509 | 2017-07-13 |
| Find all providers in CHICAGO | ||||
Please comment or provide details below to improve the information on BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS.
| 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.