NPIMap

Organization Active NPI

Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Mendota, IL
National Provider Identifier
1093981367
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Practice address
1009 Main St
Mendota, IL 61342-1604
Phone
(815) 539-6124
Fax
(815) 539-9015
NPI assigned
May 6, 2008
Last updated
Oct 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

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

Authorized official

Name
Susan Bauer, MA, MPH
Title
Executive Director
Phone
(312) 795-0000

Specialties & licenses 1

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

Addresses

Primary practice location

1009 Main St
Mendota, IL 61342-1604

Mailing address

205 W Randolph St
Suite 2222
Chicago, IL 60606-1867
Phone (312) 795-0000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130315000403 IL Part A Provider - Federally Qualified Health Center (FQHC) 6901053511 Practice locations: Mendota, IL
O20130723000458 IL Part B Supplier - Clinic/Group Practice 6901053511 Receives reassigned benefits from 39 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rantoul, IL; Princeville, IL; Mendota, IL; Harvard, IL; Champaign, IL; Aurora, IL; Kankakee, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093981367. Details of each certification follow.

Federally qualified health center certification: CCN 141193

Legal name
COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 7, 2013
Last certification
May 7, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 1991 in IL
Enrollment address
1009 Main St
Mendota, IL 61342-1604

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Partnership of Illinois12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

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
Susana Castro Individual Corporate OfficerBoard Member-President Jun 1, 1996
Gelacia Leija Individual Corporate OfficerBoard Member Jun 1, 1996
Eleace Sawyers Individual Corporate OfficerCeo Mar 9, 2020
W-2 Managing EmployeeCeo Mar 9, 2020
Operational/Managerial ControlCeo Mar 9, 2020
Maria J Martinez Individual Corporate OfficerBoard Member Feb 1, 1992
Benjamin Gonzalez Individual Corporate OfficerBoard Member-Secretary Oct 1, 2000

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446163200000",
    "number": "1093981367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W RANDOLPH ST",
            "address_2": "SUITE 2222",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061867",
            "telephone_number": "312-795-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 MAIN ST",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613421604",
            "telephone_number": "815-539-6124",
            "fax_number": "815-539-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2015-10-30",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "312-795-0000",
        "authorized_official_credential": "MA, MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendota, IL

Sources for this page

Verify at the official NPI Registry.