NPIMap

Organization Active NPI

Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1154598282
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LAWNDALE CHRISTIAN HEALTH CENTER
Practice address
3256 W 24TH St
Chicago, IL 60623-3407
Phone
(773) 843-3000
NPI assigned
May 8, 2008
Last updated
Jul 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
Karen Renee Johnson
Title
Asst Dir of Patient Accounting
Phone
(872) 588-3062

Specialties & licenses 1

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

Addresses

Primary practice location

3256 W 24TH St
Chicago, IL 60623-3407

Mailing address

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone (872) 588-3000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031120000728 IL Part B Supplier - Clinic/Group Practice 2264336346 Receives reassigned benefits from 180 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20031218000043 IL Part A Provider - Federally Qualified Health Center (FQHC) 2264336346 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154598282. Details of each certification follow.

Federally qualified health center certification: CCN 141969

Legal name
LAWNDALE CHRISTIAN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2004
Last certification
Jan 15, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1984 in IL
Enrollment address
3256 W 24TH St
Chicago, IL 60623-3217
Related CCNs
141850

Facilities connected through Provider of Services related, parent or unit certification numbers.

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 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jeanette Park Lee Individual Corporate Director Feb 1, 2018
David Wilcoxen Individual Corporate DirectorDirector of Managed Care Aug 1, 2005
Robert David Castaneda Individual Corporate Officer Jan 1, 2019
Dave Doig Individual Corporate Director Feb 1, 2018
Karen Johnson Individual W-2 Managing EmployeePatient Accounting Supervisor Oct 11, 2011
Bruce Miller Individual Corporate OfficerChief Executive Officer Jan 1, 2008
Thomas Worthy Individual Corporate Director Oct 1, 2013
Christopher Dons Individual Corporate OfficerChief Financial Officeer Nov 6, 2013

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lawndale Christian Health Center Archer AvenueChicago, IL, CCN 141107 Federally qualified health center Operational/Managerial Control Jul 1, 2009

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1154598282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3256 W 24TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233407",
            "telephone_number": "773-843-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWNDALE CHRISTIAN HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "ASST DIR OF PATIENT ACCOUNTING",
        "authorized_official_telephone_number": "872-588-3062"
    },
    "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 Chicago, IL

Sources for this page

Verify at the official NPI Registry.