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County of Lake

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

NPI 1083643118 · NPPES record last updated Aug 31, 2026

Key facts

NPI
1083643118
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COUNTY OF LAKE
Practice address
2215 Audrey Nixon Blvd
North Chicago, IL 60064-1618
Phone
(847) 984-5200
Fax
(847) 984-5240
NPI assigned
Jul 1, 2006
Organization subpart
No

Authorized official

Name
Sam Johnson
Title
Deputy Executive Director
Phone
(847) 377-8000

Owners & managing parties with NPI records 10

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

  • County of Lake Public Health or Welfare Agency · Waukegan, IL · NPI 1013920750
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Zion, IL · NPI 1023047164
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Waukegan, IL · NPI 1174552293
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Waukegan, IL · NPI 1235453309
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Highland Park, IL · NPI 1285663328
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Round Lake, IL · NPI 1639588254
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Libertyville, IL · NPI 1679900229
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Substance Use Disorder Rehabilitation Clinic/Center · Waukegan, IL · NPI 1720290091
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Round Lake Beach, IL · NPI 1750310884
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Waukegan, IL · NPI 1992155022
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of Lake Federally Qualified Health Center (FQHC) · Zion, IL · NPI 1023047164
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Waukegan, IL · NPI 1174552293
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Waukegan, IL · NPI 1235453309
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Highland Park, IL · NPI 1285663328
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Libertyville, IL · NPI 1679900229
    CMS ownership OPERATIONAL/MANAGERIAL CONTROL
  • County of Lake Federally Qualified Health Center (FQHC) · Round Lake Beach, IL · NPI 1750310884
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST

Other NPIs on the same Medicare enrollment 24

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 42

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

View all 42

Facilities with the same owner 6

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

Practitioners 50

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

View all 50

Medicare participation

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

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 · Non-profit
Enrollment address
2215 Audrey Nixon Boulevard
North Chicago, IL 60064-1618

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.

NameRoleSinceShare
Natalie D Basgall
Individual 		W-2 Managing Employee
Revenue Cycle Manager		 Mar 24, 2025 5%
Andrea Cooper
Individual 		Corporate Director
Director of Finance and Admin Cfo		 Jul 15, 2024
W-2 Managing Employee
Cfo		 Jul 15, 2024
Operational/Managerial Control
Cfo		 Jul 15, 2024
County of Lake
Organization · Waukegan, IL 		Operational/Managerial Control Sep 13, 2004

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
County of Lake
Round Lake Beach, IL · CCN 141913		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 21, 2004
Lake County Health Department and Community Health Center
Waukegan, IL · CCN 141910		 Federally qualified health center Operational/Managerial Control May 31, 2000
Lake County Health Department and Community Health Center
Zion, IL · CCN 141912		 Federally qualified health center Operational/Managerial Control Dec 1, 2000
Lake County Health Department and Community Health Center
Highland Park, IL · CCN 141096		 Federally qualified health center Operational/Managerial Control Jun 26, 2006
Lake County Health Department and Community Health Center
Waukegan, IL · CCN 141122		 Federally qualified health center Operational/Managerial Control Mar 1, 2010
Lake County Health Department and Community Health Center
Libertyville, IL · CCN 781831		 Federally qualified health center Operational/Managerial Control Dec 1, 2014

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Tax ID family
Lake County Mental Heal T (45 organizations share this tax ID)

Specialties & licenses

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

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

  • LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER Doing business as

Other providers in North Chicago, IL

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

Sources for this page

Verify at the official NPI Registry.