Active NPI
County of Lake
Doing business as Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- North Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- COUNTY OF LAKE
- Doing business as
- Lake County Health Department and Community Health Center
- Practice address
- 2215 Audrey Nixon Blvd
North Chicago, IL 60064-1618 - Phone
- (847) 984-5200
- Fax
- (847) 984-5240
- NPI assigned
- Jul 1, 2006
- Last updated
- Aug 31, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sam Johnson
- Title
- Deputy Executive Director
- Phone
- (847) 377-8000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary |
Addresses
Primary practice location
2215 Audrey Nixon Blvd
North Chicago, IL 60064-1618
Mailing address
3010 Grand Ave
Waukegan, IL 60085-2321
Phone (847) 377-8000
Other names 1
- LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040116000192 | IL | Part B Supplier - Clinic/Group Practice | 7214838861 |
Receives reassigned benefits from 148 practitioners 24 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Waukegan, IL; Zion, IL; Vernon Hills, IL; Round Lake Park, IL; Round Lake Beach, IL; Round Lake, IL; Park City, IL; North Chicago, IL… |
| O20040910000293 | IL | Part A Provider - Federally Qualified Health Center (FQHC) | 7214838861 | Practice locations: North Chicago, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1083643118. Details of each certification follow.
Federally qualified health center certification: CCN 141911
- Legal name
- COUNTY OF LAKE
- Doing business as
- LAKE COUNTY HEALTH DEPARTMENT
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 1, 2000
- Last certification
- Dec 1, 2000
- Ownership / control type
- For profit – corporation
- Organization structure
- Government
- Enrollment address
- 2215 Audrey Nixon Boulevard
North Chicago, IL 60064-1618
Other NPIs with the same Medicare PAC ID 10
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Lake County Health Department and Community Health Center
- Public Health or Welfare Agency
- Waukegan, IL
- NPI 1013920750
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Zion, IL
- NPI 1023047164
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1174552293
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1235453309
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Highland Park, IL
- NPI 1285663328
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Round Lake, IL
- NPI 1639588254
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Libertyville, IL
- NPI 1679900229
7214838861
-
dba Lake County Health Department/Community Health Center
- Substance Use Disorder Rehabilitation Clinic/Center
- Waukegan, IL
- NPI 1720290091
7214838861
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Round Lake Beach, IL
- NPI 1750310884
7214838861
-
dba Lake County Health Department/Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1992155022
7214838861
Other NPIs on the same Medicare enrollment 24
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Lake County Health Department and Community Health Center
- Public Health or Welfare Agency
- Waukegan, IL
- NPI 1013920750
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Zion, IL
- NPI 1023047164
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1053623637
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1174552293
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1174745160
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1235453309
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Public Health or Welfare Agency
- Waukegan, IL
- NPI 1255342457
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Highland Park, IL
- NPI 1285663328
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1376717702
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1477765741
O20040116000192
-
dba Lake County Health Dept and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Zion, IL
- NPI 1538380647
O20040116000192
-
dba Lake County Health Department and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1568674836
O20040116000192
National Provider Directory
National Provider Directory- Tax ID family
- Lake County Health Department
Other organizations with this tax ID 47
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Lake County Health Department and Community Health Center
- Public Health or Welfare Agency
- Waukegan, IL
- NPI 1013920750
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Zion, IL
- NPI 1023047164
-
dba Lake County Health Department and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1053623637
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1174552293
-
dba Lake County Health Department and Community Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1174745160
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Park City, IL
- NPI 1194638940
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1235453309
-
dba Lake County Health Department and Community Health Center
- Public Health or Welfare Agency
- Waukegan, IL
- NPI 1255342457
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Highland Park, IL
- NPI 1285663328
-
dba Lake County Health Department and Community Health Center
- Substance Use Disorder Rehabilitation Clinic/Center
- Waukegan, IL
- NPI 1356888515
-
dba Nineteenth Judicial Circuit
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Vernon Hills, IL
- NPI 1417243288
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waukegan, IL
- NPI 1457272585
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Natalie D Basgall | W-2 Managing Employee | Mar 24, 2025 | 5% |
| Andrea Cooper | Corporate Director | Jul 15, 2024 | |
| W-2 Managing Employee | Jul 15, 2024 | ||
| Operational/Managerial Control | Jul 15, 2024 | ||
| County of Lake | Operational/Managerial Control | Sep 13, 2004 |
Owners & managing parties with NPI records 10
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Lake County Health Department and Community Health Center
- Public Health or Welfare Agency
- Waukegan, IL
- NPI 1013920750
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Zion, IL
- NPI 1023047164
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1174552293
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1235453309
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Highland Park, IL
- NPI 1285663328
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Round Lake, IL
- NPI 1639588254
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Libertyville, IL
- NPI 1679900229
Operational/Managerial Control
-
dba Lake County Health Department/Community Health Center
- Substance Use Disorder Rehabilitation Clinic/Center
- Waukegan, IL
- NPI 1720290091
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Round Lake Beach, IL
- NPI 1750310884
Operational/Managerial Control
-
dba Lake County Health Department/Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1992155022
Operational/Managerial Control
All facility ownership & control disclosures 6
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| County of Lake | Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 21, 2004 |
| Lake County Health Department and Community Health Center | Federally qualified health center | Operational/Managerial Control | May 31, 2000 |
| Lake County Health Department and Community Health Center | Federally qualified health center | Operational/Managerial Control | Dec 1, 2000 |
| Lake County Health Department and Community Health Center | Federally qualified health center | Operational/Managerial Control | Jun 26, 2006 |
| Lake County Health Department and Community Health Center | Federally qualified health center | Operational/Managerial Control | Mar 1, 2010 |
| Lake County Health Department and Community Health Center | Federally qualified health center | Operational/Managerial Control | Dec 1, 2014 |
Owned or controlled facilities with NPI records 6
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Zion, IL
- NPI 1023047164
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1174552293
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1235453309
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Highland Park, IL
- NPI 1285663328
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Libertyville, IL
- NPI 1679900229
Operational/Managerial Control
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Round Lake Beach, IL
- NPI 1750310884
5% Or Greater Direct Ownership Interest
Facilities with the same owner 6
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Zion, IL
- NPI 1023047164
County of Lake
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1174552293
County of Lake
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Waukegan, IL
- NPI 1235453309
County of Lake
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Highland Park, IL
- NPI 1285663328
County of Lake
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Libertyville, IL
- NPI 1679900229
County of Lake
-
dba Lake County Health Department and Community Health Center
- Federally Qualified Health Center (FQHC)
- Round Lake Beach, IL
- NPI 1750310884
County of Lake
Practitioners & affiliated clinicians
Practitioners 11
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.
-
- Obstetrics & Gynecology Physician
- Ottawa, IL
- NPI 1891727236
-
- Family Medicine Physician
- Northbrook, IL
- NPI 1811250681
-
- Counselor
- Waukegan, IL
- NPI 1467904870
-
- Dentist
- Waukegan, IL
- NPI 1154446318
-
- Family Nurse Practitioner
- Skokie, IL
- NPI 1528504909
-
- Family Nurse Practitioner
- Zion, IL
- NPI 1588448880
-
- Public Health & General Preventive Medicine Physician
- Westchester, IL
- NPI 1467664946
-
- Family Nurse Practitioner
- Round Lake Beach, IL
- NPI 1972975639
-
- Nurse Practitioner
- Woodstock, IL
- NPI 1851862817
-
- Family Medicine Physician
- La Mesa, CA
- NPI 1508802828
-
- Psychiatry Physician
- Woodbury, MN
- NPI 1750649455
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788134400000",
"number": "1083643118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3010 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852321",
"telephone_number": "847-377-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2215 AUDREY NIXON BLVD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600641618",
"telephone_number": "847-984-5200",
"fax_number": "847-984-5240"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF LAKE",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-01",
"last_updated": "2026-08-31",
"certification_date": "2026-08-31",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "SAM",
"authorized_official_title_or_position": "DEPUTY EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "847-377-8000"
},
"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": "LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in North Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.