Community Health & Emergency Services, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Harrisburg, IL
NPI 1013976919 · NPPES record last updated Sep 1, 2010
Key facts
- NPI
- 1013976919
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH & EMERGENCY SERVICES, INC
- Practice address
- 205 N Main St
Harrisburg, IL 62946-1272 - Phone
- (618) 253-8450
- Fax
- (618) 253-8454
- NPI assigned
- Mar 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Frederick Bernstein
- Title
- C.E.O.
- Phone
- (618) 457-0450
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 17
Related certifications (CCN) 1
Practitioners 14
-
Maureen Jane Klemme, CNP
-
Kari Nicole Koster, R.N., A.P.R.N.
-
Lilee Robinson, PA C
-
Elizabeth Ann Bebout, PAC
-
Rebekah B Bogan, FNP
-
Robert Daniel Dansby III, APRN
-
Leon Gauthier, PA-C
-
Razia Sami, M.D
-
Natasha Charlyn Shafer, FNP-BC
-
Valerie A. Wilson, LCSW
-
James A Schwab, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1046429 | Harrisburg Community Health Center | Certificate of waiver | Apr 19, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Federally qualified health center certification: CCN 141019
- Legal name
- COMMUNITY HEALTH & EMERGENCY SERVICES INC
- Doing business as
- HARRISBURG COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 26, 2005
- Last certification
- Oct 26, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 29, 1981 in IL
- Enrollment address
- 205 North Main Street
Harrisburg, IL 62946-0352 - Related CCNs
- 141813
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Kanci Houston |
Corporate Director |
May 1, 2023 | |
| Operational/Managerial Control | May 1, 2023 | ||
| Josie Eason |
Corporate Officer |
Jul 31, 2007 | |
| Heather Green |
Corporate Officer | Jan 1, 2017 | |
| Charles Soward |
Corporate Officer |
Jul 22, 1996 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050914000626 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 0749194702 | Practice locations: Harrisburg, IL |
National Provider Directory
- Tax ID family
- Community Health Emer
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
205 N Main St
Harrisburg, IL 62946-1272
Mailing address
PO Box 3008
Carbondale, IL 62902-3008
Phone (618) 457-0450
Other names
- HARRISBURG MEDICAL CLINIC
Other providers in Harrisburg, IL
- City of Harrisburg
- Anne Melinda Clayton
- Morgan Rachael Colbert
- Coleman Tri-County Services, Inc.
- Carla Sue Collins
- Community Health & Emergency Services, Inc.
- David Michael Cook
- Chris Ann Cox
- Alicia Crisenbery
- CT Scan Center, Inc.
All providers in Harrisburg, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.