MEDICARE: ASCENSION ST JOHN HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	207UN0901X	Nuclear Cardiology Physician
4	2085N0904X	Nuclear Radiology Physician
5	2085R0202X	Diagnostic Radiology Physician
6	207W00000X	Ophthalmology Physician
7	207X00000X	Orthopaedic Surgery Physician
8	208000000X	Pediatrics Physician
9	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700E031610	OTHER	MI	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1457663197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION ST JOHN HOSPITAL

Provider Business Mailing Address
First Line	:	3187 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-3001
Country	:	US
Telephone Number	:	248-680-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3187 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-2468
Country	:	US
Telephone Number	:	248-680-8000
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	SARAH STARKEL
Credential	:
Telephone Number	:	248-680-8121

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	03/18/2025

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Directions to “ASCENSION ST JOHN HOSPITAL ” Practice Location

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