NPIMap

Organization Active NPI

Will County Community Health Center

Doing business as Will County Community Health Center East

  • Federally Qualified Health Center (FQHC)
  • Monee, IL
National Provider Identifier
1053870204
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WILL COUNTY COMMUNITY HEALTH CENTER
Doing business as
Will County Community Health Center East
Practice address
5601 W Monee Manhattan Rd Ste 109
Monee, IL 60449-8864
Phone
(815) 727-8670
Fax
(815) 846-8932
NPI assigned
Mar 18, 2019
Last updated
Mar 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
WILL COUNTY COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Authorized official

Name
Susan Olenek
Title
Executive Director
Phone
(815) 740-8982

Specialties & licenses 1

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

Addresses

Primary practice location

5601 W Monee Manhattan Rd Ste 109
Monee, IL 60449-8864

Mailing address

5601 W Monee Manhattan Rd Ste 109
Monee, IL 60449-8864
Phone (815) 727-8670

Other identifiers 1

IdentifierTypeStateIssuer
H80CS00476OtherHRSA GRANT NUMBER

Other names 1

  • Will County Community Health Center East Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000197 IL Part B Supplier - Clinic/Group Practice 5395633317 Receives reassigned benefits from 32 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bolingbrook, IL; Joliet, IL; Monee, IL
O20190516000915 IL Part A Provider - Federally Qualified Health Center (FQHC) 5395633317 Practice locations: Monee, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053870204. Details of each certification follow.

Federally qualified health center certification: CCN 781925

Legal name
WILL COUNTY COMMUNITY HEALTH CENTER
Doing business as
WILL COUNTY COMMUNITY HEALTH CENTER EAST
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 16, 2019
Last certification
May 16, 2019
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jun 24, 1994 in IL
Enrollment address
5601 W Monee Manhattan Rd
Ste 109
Monee, IL 60449-8864

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Will Co Community Healt5 organizations share this tax ID, including this one
Part of
Will Co Community Healt

Other organizations with this tax ID 4

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

323 Quadrangle Dr
Bolingbrook, IL 60440
Phone (630) 679-7000

391 Quadrangle Dr
Ste 130
Bolingbrook, IL 60440
Phone (630) 679-7000

5601 W Monee Manhattan Rd
Ste 109
Monee, IL 60449
Phone (815) 727-8670

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
Elizabeth Bilotta Individual W-2 Managing EmployeeExecutive Director Feb 4, 2023
Will County Community Health Center Organization, Joliet, IL Corporation, Non-profit Operational/Managerial Control May 6, 2019 100%
Denise Bergin Individual W-2 Managing EmployeeAssistant Executive Director Apr 17, 2023
County of Will Organization, Joliet, IL 5% Or Greater Direct Ownership Interest May 6, 2019 100%

Owners & managing parties with NPI records 4

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1053870204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 W MONEE MANHATTAN RD STE 109",
            "city": "MONEE",
            "state": "IL",
            "postal_code": "604498864",
            "telephone_number": "815-727-8670",
            "fax_number": "815-846-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 W MONEE MANHATTAN RD STE 109",
            "city": "MONEE",
            "state": "IL",
            "postal_code": "604498864",
            "telephone_number": "815-727-8670",
            "fax_number": "815-846-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILL COUNTY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILL COUNTY COMMUNITY HEALTH CENTER",
        "enumeration_date": "2019-03-18",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "OLENEK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-740-8982"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HRSA GRANT NUMBER",
            "identifier": "H80CS00476",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Will County Community Health Center East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monee, IL

Sources for this page

Verify at the official NPI Registry.