NPIMap

Organization Active NPI

Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Melrose Park, IL
National Provider Identifier
1104905702
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ACCESS COMMUNITY HEALTH NETWORK
Practice address
8321 W North Ave
Melrose Park, IL 60160-1605
Phone
(708) 672-2298
NPI assigned
Nov 3, 2006
Last updated
Mar 22, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Authorized official

Name
Donna Thompson
Title
Ceo
Phone
(312) 526-2051

Specialties & licenses 1

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

Addresses

Primary practice location

8321 W North Ave
Melrose Park, IL 60160-1605

Mailing address

600 W Fulton
Suite 200
Chicago, IL 60661-1262
Phone (312) 526-2051

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030702000037 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537076112 Practice locations: Melrose Park, IL
O20031204000985 IL Part B Supplier - Clinic/Group Practice 9537076112 Receives reassigned benefits from 512 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Chicago Heights, IL; Cicero, IL; Des Plaines, IL; Evanston, IL; Heights, IL; Melrose Park, IL; Summit, IL…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104905702. Details of each certification follow.

Federally qualified health center certification: CCN 141928

Legal name
ACCESS COMMUNITY HEALTH NETWORK
Doing business as
MELROSE PARK FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 9, 2002
Last certification
Sep 9, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 11, 1984 in IL
Enrollment address
8321 W North Avenue
Melrose Park, IL 60160-1605
Related CCNs
141867

National Provider Directory

National Provider Directory
Tax ID family
Access Comunity Health29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

654 E 47th St
Chicago, IL 60653
Phone (773) 624-4800

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Donna Thompson Individual Corporate OfficerCeo Jul 1, 1995 100%
W-2 Managing EmployeeCeo Jul 1, 1995 100%
David Wise Individual Corporate DirectorBoard Member Jul 1, 2010
Thomas P Fitzgibbon Individual Corporate DirectorBoard Member Mar 1, 2013
Delphine Goree Individual Corporate DirectorBoard Member Jul 1, 2010
Virginia Oviedo Individual Corporate DirectorBoard Member Apr 1, 2011
Denise Kitchen Individual Corporate DirectorBoard Member Jun 1, 2007
Patricia Bobb Individual Corporate DirectorBoard Member Jul 1, 2010
Donna Simmons Individual Corporate DirectorBoard Member Mar 1, 2010
Daniela Levitt Individual Corporate DirectorBoard Member Jul 1, 2010
Terry Brown Individual Corporate DirectorBoard Member Mar 1, 2000
Marilyn Scott Individual Corporate DirectorBoard Member Mar 1, 2013
Robert Sheesly Individual Corporate DirectorBoard Member Jul 1, 2010
Derrick Tung Individual Corporate DirectorBoard Member Jun 1, 2010
Erin Starkey Individual Corporate DirectorBoard Member Jul 1, 2010
Ryan Hart Individual Corporate DirectorBoard Member Mar 1, 2013
Charles Deshazer Individual Corporate DirectorBoard Member Apr 1, 2011
Adrienne Watson Individual Corporate DirectorBoard Member Mar 1, 2000

Practitioners & affiliated clinicians

Practitioners 11

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": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1104905702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W FULTON",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606611262",
            "telephone_number": "312-526-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8321 W NORTH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601605",
            "telephone_number": "708-672-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-526-2051"
    },
    "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 Melrose Park, IL

Sources for this page

Verify at the official NPI Registry.