NPIMap

Organization Active NPI

Community Health & Emergency Services, Inc

Doing business as Harrisburg Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Harrisburg, IL
National Provider Identifier
1013976919
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH & EMERGENCY SERVICES, INC
Doing business as
Harrisburg Medical Clinic
Practice address
205 N Main St
Harrisburg, IL 62946-1272
Phone
(618) 253-8450
Fax
(618) 253-8454
NPI assigned
Mar 20, 2006
Last updated
Sep 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Frederick Bernstein
Title
C.E.O.
Phone
(618) 457-0450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 1

  • HARRISBURG MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050914000626 IL Part A Provider - Federally Qualified Health Center (FQHC) 0749194702 Practice locations: Harrisburg, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013976919. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 29, 1981 in IL
Enrollment address
205 North Main Street
Harrisburg, IL 62946-0352
Related CCNs
141813

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1046429Harrisburg Community Health Center205 N Main Street, Harrisburg, IL 62946Certificate of waiverApr 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Health Emerg18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

205 N Main St
Harrisburg, IL 62946
Phone (618) 253-8450

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kanci Houston Individual Corporate DirectorCeo May 1, 2023
Operational/Managerial Control May 1, 2023
Josie Eason Individual Corporate OfficerBoard Member Jul 31, 2007
Heather Green Individual Corporate Officer Jan 1, 2017
Charles Soward Individual Corporate OfficerBoard Member Jul 22, 1996

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283299200000",
    "number": "1013976919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3008",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023008",
            "telephone_number": "618-457-0450",
            "fax_number": "618-457-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N MAIN ST",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629461272",
            "telephone_number": "618-253-8450",
            "fax_number": "618-253-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH & EMERGENCY SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2010-09-01",
        "status": "A",
        "authorized_official_last_name": "BERNSTEIN",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "618-457-0450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HARRISBURG MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrisburg, IL

Sources for this page

Verify at the official NPI Registry.