NPIMap

Organization Active NPI

Tca Health Inc NFP

  • Federally Qualified Health Center (FQHC)
  • Hammond, IN
National Provider Identifier
1093404576
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TCA HEALTH INC NFP
Practice address
5504 Hohman Ave
Hammond, IN 46320-1933
Phone
(773) 995-6300
Fax
(773) 995-7985
NPI assigned
May 2, 2023
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TCA HEALTH INC NFPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Veronica Clarke
Title
Ceo
Phone
(773) 995-1940

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU

Addresses

Primary practice location

5504 Hohman Ave
Hammond, IN 46320-1933

Mailing address

1029 E 130TH St
Chicago, IL 60628-6908
Phone (773) 995-6300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240827003602 IN Part A Provider - Federally Qualified Health Center (FQHC) 5991696643 Practice locations: Hammond, IN
O20241207000295 IN Part B Supplier - Clinic/Group Practice 5991696643 Receives reassigned benefits from 5 practitioners
Practice locations: Hammond, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093404576. Details of each certification follow.

Federally qualified health center certification: CCN C51053

Legal name
TCA HEALTH INC NFP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 3, 2024
Last certification
Sep 3, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 2015 in IL
Enrollment address
5504 Hohman Ave
Hammond, IN 46320-1933

Other NPIs with the same Medicare PAC ID 3

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

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
15D2303554Tca Health, Inc5504 Hohman Ave, Hammond, IN 46320Certificate of waiverApr 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Clinic in Aitgeid Inc7 organizations share this tax ID, including this one
Part of
Clinic in Aitgeid Inc

Other organizations with this tax ID 6

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

Locations

5504 Hohman Ave
Hammond, IN 46320
Phone (773) 995-6300

5504 Hohman Ave
Hammond, IN 46320
Phone (773) 995-6300

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Willie McShan Individual Corporate DirectorBoard Member Jan 1, 2010
Leonardo D. Gilbert Individual Corporate DirectorBoard Member Jan 1, 2010
Michael C. Fountain Individual Corporate DirectorBoard Member Jan 1, 2013
Edna Chima Individual Corporate Director Jan 25, 2011
Veronica Clarke Individual Corporate OfficerCeo Nov 16, 2015
Operational/Managerial ControlCeo Nov 16, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tca Health ChathamChicago, IL, CCN 781846 Federally qualified health center Operational/Managerial Control Nov 1, 2015

Owned or controlled facilities with NPI records 1

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

  • Tca Health Inc NFP

    dba Tca Health Chatham

    • Federally Qualified Health Center (FQHC)
    • Chicago, IL
    • NPI 1578936696

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1682985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1093404576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 E 130TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606286908",
            "telephone_number": "773-995-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5504 HOHMAN AVE",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463201933",
            "telephone_number": "773-995-6300",
            "fax_number": "773-995-7985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TCA HEALTH INC NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TCA HEALTH INC NFP",
        "enumeration_date": "2023-05-02",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-995-1940"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, IN

Sources for this page

Verify at the official NPI Registry.