NPIMap

Organization Active NPI

Heartland Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Pekin, IL
National Provider Identifier
1104276492
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEARTLAND COMMUNITY HEALTH CLINIC
Practice address
19 Olt Ave
Pekin, IL 61554-6214
Phone
(309) 680-7600
Fax
(309) 353-3334
NPI assigned
Jun 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Authorized official

Name
Katie Saucedo
Title
Revenue Cycle Manager
Phone
(309) 680-7600

Specialties & licenses 1

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

Addresses

Primary practice location

19 Olt Ave
Pekin, IL 61554-6214

Mailing address

2214 N University St
Peoria, IL 61604-3221
Phone (309) 680-7600

Other names 1

  • Heartland Health Services - Olt Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170608000958 IL Part B Supplier - Clinic/Group Practice 7416850318 Receives reassigned benefits from 12 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Peoria, IL; Pekin, IL
O20170718003582 IL Part A Provider - Federally Qualified Health Center (FQHC) 7416850318 Practice locations: Pekin, IL

Federally qualified health center certification: CCN 781881

Legal name
HEARTLAND COMMUNITY HEALTH CLINIC
Doing business as
HEARTLAND HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 20, 2017
Last certification
Jul 20, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1990 in IL
Enrollment address
19 Olt Ave
Pekin, IL 61554-6214

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 6

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

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
14D2115339Heartland Health Services - Olt19 Olt Ave, Pekin, IL 61554Provider-performed microscopyJul 4, 2026
14D2325304Heartland Health Services - Mobile Health Unit19 Olt Ave, Pekin, IL 61554Certificate of waiverJun 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Heartland Community Health Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

3248 Vandever Ave
Ste B
Pekin, IL 61554

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Sally G Cloyd Individual Corporate DirectorBoard Member Apr 29, 2016
Melody L Shake Individual Corporate OfficerVPQC Apr 26, 2017
W-2 Managing EmployeeVPQC Apr 26, 2017
Todd J Baker Individual Corporate Director Mar 22, 2019
Janet a Goldsworthy Individual Corporate DirectorBoard Member Apr 29, 2016
Craig D Williams Individual Corporate DirectorBoard Member Apr 26, 2017
Andrew a Rand Individual Corporate DirectorBoard Member Apr 29, 2016
Sarah P Snyder Individual Corporate DirectorBoard Member Apr 29, 2016
Alneida Ford Individual Corporate DirectorBoard Member Apr 29, 2016
David C Stenerson Individual Corporate Director Jul 30, 2018
Staci D Ogborn Individual Corporate OfficerCS Jul 30, 2018
W-2 Managing EmployeeCS Jul 30, 2018
Laurie K Covington Individual Corporate DirectorBoard Member Apr 29, 2016
Linda a Fox Individual Corporate DirectorBoard Member Apr 29, 2016
Gregg D Stoner Individual Corporate OfficerCmo Jul 31, 2017
W-2 Managing EmployeeCmo Jul 31, 2017
Stephen E Bash Individual Corporate DirectorBoard Member Apr 29, 2016
Antonio S Banegas Individual Corporate DirectorBoard Member Apr 26, 2017
Michael J Cohlman Individual Corporate OfficerCfo Mar 22, 2019
W-2 Managing EmployeeCfo Mar 22, 2019
Sharon a Adams Individual Corporate OfficerCeo Mar 22, 2019
W-2 Managing EmployeeCeo Mar 22, 2019
Maria G Herrera Individual Corporate DirectorBoard Member Apr 29, 2016
Robert G Grove Individual Corporate DirectorBoard Member Apr 29, 2016
Wayne W Cannon Individual Corporate Director Jul 30, 2018
Gale S Thetford Individual Corporate DirectorBoard Member Apr 29, 2016

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 51

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

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1104276492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 OLT AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546214",
            "telephone_number": "309-680-7600",
            "fax_number": "309-353-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND COMMUNITY HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A",
        "authorized_official_last_name": "SAUCEDO",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "309-680-7600"
    },
    "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": "Heartland Health Services - Olt",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pekin, IL

Sources for this page

Verify at the official NPI Registry.