NPIMap

Organization Active NPI

Preferred Family Healthcare, Inc.

Doing business as Clarity Healthcare

  • Federally Qualified Health Center (FQHC)
  • Quincy, IL
National Provider Identifier
1124499074
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PREFERRED FAMILY HEALTHCARE, INC.
Doing business as
Clarity Healthcare
Practice address
540 Harrison St
Quincy, IL 62301-7236
Phone
(573) 603-1460
Fax
(573) 603-1462
NPI assigned
Oct 16, 2015
Last updated
Jun 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Authorized official

Name
Mark Conover
Title
Chief Revenue Officer
Phone
(660) 665-1962

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

540 Harrison St
Quincy, IL 62301-7236

Mailing address

1601 Old South River Rd
Saint Charles, MO 63303-4120

Other names 1

  • Clarity Healthcare Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151105002841 IL Part A Provider - Federally Qualified Health Center (FQHC) 0244256246 Practice locations: Quincy, IL
O20151124002928 IL Part B Supplier - Clinic/Group Practice 0244256246 Receives reassigned benefits from 15 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quincy, IL; Pittsfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124499074. Details of each certification follow.

Federally qualified health center certification: CCN 781843

Legal name
PREFERRED FAMILY HEALTHCARE INC
Doing business as
CLARITY HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 9, 2015
Last certification
Nov 9, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 20, 2007 in MO
Enrollment address
540 Harrison St
Quincy, IL 62301-7236

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Preferred Family Healthcare149 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

540 Harrison St
Quincy, IL 62301
Phone (217) 222-6277

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Larry Shawn Sando Individual W-2 Managing EmployeeCeo, Centerstone Medical Group Nov 1, 2025
Lisa Fairley Individual Corporate DirectorVice Chair, Board of Directors Jun 29, 2004
Jennifer L Gagnon Individual Corporate OfficerCfo Jan 1, 2022
Thomas Weber Individual Corporate OfficerDivision President, West Jan 2, 2015
Amanda R Carter Individual Corporate OfficerVice President, Managed Care Jan 22, 2018
Jim Bergman Individual Corporate DirectorBoard Member Sep 18, 2019
David Guth Individual Corporate OfficerCeo Nov 1, 2025
Robert Berry Individual Corporate DirectorBoard Chair Sep 21, 2011
Elphanie Swift Individual Corporate DirectorBoard Member Sep 18, 2019
Stanley Melton Individual Corporate DirectorBoard Member Dec 15, 2011
Anthony Henderson Individual Corporate DirectorBoard Secretary Mar 15, 2015
Carol Bean Individual Corporate OfficerDivision President, East Nov 1, 2025
John J Benson Individual Corporate DirectorBoard Member Feb 25, 1988
Carl D Davis Individual Corporate OfficerCeo Elect Jan 1, 2022
Sharon Brown Individual Corporate DirectorBoard Member Jan 15, 2003
Donald Crosby Individual Corporate DirectorTreasurer, Board of Directors Jul 26, 2018

Practitioners & affiliated clinicians

Practitioners 3

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": "1444953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1124499074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 OLD SOUTH RIVER RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633034120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 HARRISON ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623017236",
            "telephone_number": "573-603-1460",
            "fax_number": "573-603-1462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED FAMILY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-16",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "CONOVER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF REVENUE OFFICER",
        "authorized_official_telephone_number": "660-665-1962"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarity Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clarity Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.