Whiteside County Community Health Clinic

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

WHITESIDE COUNTY COMMUNITY HEALTH CLINIC

Practice address

306 S Hennepin Ave
Dixon, IL 61021-3020

Phone

(815) 626-2230

NPI assigned

May 20, 2021

Organization subpart

No

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

Authorized official

Name

Cheryl L Lee

Title

Pha/Ceo

Phone

(815) 626-2230

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 781010

Legal name

WHITESIDE COUNTY COMMUNITY HEALTH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 2, 2021

Last certification

Dec 2, 2021

Ownership / control type

For profit – corporation

Facility address

306 S Hennepin Ave
Dixon, IL 61021

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1093389322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W 2ND ST",
            "city": "ROCK FALLS",
            "state": "IL",
            "postal_code": "610711005",
            "telephone_number": "815-626-2230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213020",
            "telephone_number": "815-626-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITESIDE COUNTY COMMUNITY HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHA/CEO",
        "authorized_official_telephone_number": "815-626-2230"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin McAvoy Wheatley, DPM
• Alison Danielle White
• Jeffrey G. White, MPT
• Michelle Marie White, PTA
• William E White, CADC
• Whiteside County Community Health Clinic
• Glen Wicks, RBT
• Wendy Wiersema, LPN
• Briann Wiezorek, RBT
• Rebecca S Wildman, M.A., QMHP

• Federally Qualified Health Center (FQHC) in Dixon, IL
• Providers in Dixon, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; 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.

Verify at the official NPI Registry.