Access Community Health Network

Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago, IL

NPI 1043398217 · NPPES record last updated Dec 10, 2018

Key facts

NPI
1043398217
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
ACCESS COMMUNITY HEALTH NETWORK
Practice address
5159 S Ashland Ave
Chicago, IL 60609-4931
Phone
(773) 434-9216
Fax
(773) 434-2670
NPI assigned
Nov 2, 2006
Organization subpart
No

Authorized official

Name
Donna Thompson
Title
Ceo
Phone
(312) 526-2051

Corporate family (same tax ID) 28

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

View all 28

Practitioners 154

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 154

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Federally qualified health center certification: CCN 141898

Legal name
ACCESS COMMUNITY HEALTH NETWORK
Doing business as
ASHLAND FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 14, 2000
Last certification
Jul 14, 2000
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Aug 11, 1984 in IL
Enrollment address
5159 S Ashland Ave
Chicago, IL 60609-4931
Related CCNs
141867

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Perla Herrera
Individual
Corporate Director Sep 1, 2013
Donna Thompson
Individual
Corporate Officer
Ceo
Jul 1, 1995 100%
Corporate Director Mar 1, 2013
W-2 Managing Employee
Ceo
Jul 1, 1995 100%
David Wise
Individual
Corporate Director Jul 1, 2010
Thomas P Fitzgibbon
Individual
Corporate Director Mar 1, 2013
Delphine Goree
Individual
Corporate Director Jul 1, 2010
Virginia Oviedo
Individual
Corporate Director Apr 1, 2011
Julio Morejon
Individual
Corporate Director Jul 1, 2019
Denise Kitchen
Individual
Corporate Director Jun 1, 2007
Patricia Bobb
Individual
Corporate Director Jul 10, 2010
Donna Simmons
Individual
Corporate Director Mar 1, 2000
Daniela Levitt
Individual
Corporate Director Jul 1, 2010
Peter McNerney
Individual
Corporate Director Feb 10, 2015
Terry Brown
Individual
Corporate Director Mar 1, 2000
Elizabeth Perez
Individual
Corporate Director Sep 1, 2017
Matthew Berkley
Individual
Corporate Director Jun 1, 2018
Marilyn Scott
Individual
Corporate Director Mar 1, 2013
Robert Sheesly
Individual
Corporate Director Jul 1, 2010
Lilia Gonzalez
Individual
Corporate Director Jan 1, 2018
Derrick Tung
Individual
Corporate Director Jun 1, 2010
Miriam Mobley-Smith
Individual
Corporate Director Sep 1, 2017
Erin Starkey
Individual
Corporate Director Jul 1, 2010
Ryan Hart
Individual
Corporate Director Mar 1, 2013
Sharon Gibson
Individual
Corporate Director Jan 1, 2018
Charles Deshazer
Individual
Corporate Director Apr 1, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031204000985 IL Part B Supplier - Clinic/Group Practice 9537076112 Receives reassigned benefits from 512 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Chicago Heights, IL; Cicero, IL; Des Plaines, IL; Evanston, IL; Heights, IL; Melrose Park, IL; Summit, IL…
O20101119000160 IL Part a Provider - Federally Qualified Health Center (FQHC) 9537076112 Practice locations: Chicago, IL

National Provider Directory

Tax ID family
Access Community Health (29 organizations share this tax ID)

Locations

2701 W 68th St
Ste S3
Chicago, IL 60629

3229 W 47th Pl
#43
Chicago, IL 60632
Phone (773) 254-6044

1723 W Howard St
Chicago, IL 60626

2653 W Ogden Ave
Ste 3B
Chicago, IL 60608
Phone (773) 522-6100

4909 W Division St
Ste 508
Chicago, IL 60651
Phone (312) 526-2200

2701 W 68th St
#3
Chicago, IL 60629
Phone (773) 434-4040

3700 W 26th St
Chicago, IL 60623
Phone (773) 542-5203

245 W Roosevelt Rd
Ste S150
West Chicago, IL 60185

Specialties & licenses

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

Addresses

Primary practice location

5159 S Ashland Ave
Chicago, IL 60609-4931

Mailing address

600 W Fulton
Suite 200
Chicago, IL 60661-1262
Phone (312) 526-2051

Other providers in Chicago, IL

All providers in Chicago, IL · Federally Qualified Health Center (FQHC) in Illinois

Sources for this page

Verify at the official NPI Registry.