FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC
NPI 1740304757
Clinic/Center - Occupational Medicine in Chicago, IL
NPI Status: Active since March 16, 2007
Contact Information
3409 W FULLERTON AVE
CHICAGO, IL
ZIP 60647
Phone: (773) 486-5001
- Organization
- Clinic/Center
- Occupational Medicine
- CLIA Number: 14D1078393
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 01-08-2026
About FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC
This page provides the complete NPI Profile along with additional information for Fullerton Occupational Medicine & Immediate Care Sc, a provider established in Chicago, Illinois operating as a Clinic/center, focusing in occupational medicine . The healthcare provider is registered in the NPI registry with number 1740304757 assigned on March 2007. The practitioner's primary taxonomy code is 261QX0100X with license number 364061160 (IL). The provider is registered as an organization and their NPI record was last updated 16 years ago. The authorized official of this NPI record is Renlin Xia Md (President)
- NPI
- 1740304757
- Provider Name
- FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC
- Entity Type
- Organization
- Location Address
- 3409 W FULLERTON AVE CHICAGO, IL 60647
- Location Phone
- (773) 486-5001
- Mailing Address
- 3409 W FULLERTON AVE CHICAGO, IL 60647
- Mailing Phone
- (773) 486-5001
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-16-2007
- Last Update Date
- 04-13-2010
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Occupational Medicine
- Taxonomy Code
- 261QX0100X
- Type
- Ambulatory Health Care Facilities
- License No.
- 364061160
- License State
- IL
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | 364061160 (IL) |
| 2 | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | 364061160 (IL) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 01635426 | OTHER (01) | IL | OTHER |
| 036088691 4 | MEDICAID (05) | IL | |
| G21025 | MEDICARE UPIN (02) | IL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D1078393
- Facility Type
- Physician Office
- Certificate Effective Date
- January 09, 2024
- Certificate Expiration Date
- January 08, 2026
- Laboratory Director
- JACQUELINE OLIVO M D
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Fullerton Occupational Medicine & Immediate Care Sc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1740304757, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 63 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1740304757, enumerated as an "organization" on March 16, 2007.
The provider is located at 3409 W FULLERTON AVE CHICAGO, IL 60647 and the phone number is (773) 486-5001.
Clinic/Center with taxonomy code 261QX0100X and a focus in Occupational Medicine.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
