NPIMap

Organization Active NPI

Erie Family Health Center Inc

Doing business as Erie Johnson Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1043407547
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ERIE FAMILY HEALTH CENTER INC
Doing business as
Erie Johnson Health Center
Practice address
1504 S Albany
Chicago, IL 60623-2209
Phone
(312) 666-3494
Fax
(312) 666-0610
NPI assigned
Sep 28, 2007
Last updated
Nov 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Authorized official

Name
Lee Francis
Title
President and Ceo
Phone
(312) 432-7394

Specialties & licenses 1

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

Addresses

Primary practice location

1504 S Albany
Chicago, IL 60623-2209

Mailing address

1701 W Superior
Chicago, IL 60622-5646
Phone (312) 666-3494

Other identifiers 2

IdentifierTypeStateIssuer
1616827OtherILBLUE CROSS BLUE SHIELD PROVIDE NUMBER
748480OtherILMEDICARE PART B

Other names 1

  • Erie Johnson Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000689 IL Part B Supplier - Clinic/Group Practice 9537050422 Receives reassigned benefits from 396 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Evanston, IL; Lake Forest, IL; Waukegan, IL
O20060919000610 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537050422 1 other NPI on this enrollment
Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043407547. Details of each certification follow.

Federally qualified health center certification: CCN 141035

Legal name
ERIE FAMILY HEALTH CENTER, INC
Doing business as
ERIE JOHNSON SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 28, 2006
Last certification
Nov 28, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 24, 1976 in IL
Enrollment address
1504 S Albany Ave
Chicago, IL 60623-2209
Related CCNs
141829

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

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
14D0996865Erie Johnson School Based Health Center1504 S Albany, Chicago, IL 60623Provider-performed microscopyMay 8, 2028

National Provider Directory

National Provider Directory

Locations

1701 W Superior St
Fl 2
Chicago, IL 60622
Phone (323) 361-2122

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Celeste Castillo Individual Corporate OfficerSecretary Dec 1, 2007
Brian Marsella Individual Corporate DirectorBoard Chair Jul 1, 2011
Lee Francis Individual Corporate OfficerPresident and Ceo Jul 1, 2008
Stephanie Smith Individual Corporate OfficerCfo Oct 13, 2025
Operational/Managerial ControlCfo Oct 13, 2025
Caroline M Hoke Individual Corporate OfficerChief Clinical Officer Mar 6, 2018
William Kistner Individual Corporate DirectorBoard Treasurer Jul 1, 2002
Mychel Owens Individual W-2 Managing EmployeeManager, Managed Care Oct 22, 2022
Amy Valukas Individual W-2 Managing EmployeeChief Population Health Officer Jul 3, 2016
Carolyn a Dickens Individual Corporate OfficerVice Chair Nov 1, 2017
Eric Mayeda Individual Corporate DirectorDirector Sep 15, 2004

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1043407547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-666-3494",
            "fax_number": "312-666-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 S ALBANY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232209",
            "telephone_number": "312-666-3494",
            "fax_number": "312-666-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "FRANCIS",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "312-432-7394"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PROVIDE NUMBER",
            "identifier": "1616827",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "748480",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Erie Johnson Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Erie Johnson Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.