NPIMap

Organization Active NPI

Tca Health Inc NFP

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1164149100
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TCA HEALTH INC NFP
Practice address
13336 S Baltimore, 1St Floor
Chicago, IL 60633-1425
Phone
(773) 995-6300
NPI assigned
Oct 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

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

Authorized official

Name
Veronica Clarke
Title
Ceo
Phone
(773) 995-1940

Specialties & licenses 1

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

Addresses

Primary practice location

13336 S Baltimore, 1St Floor
Chicago, IL 60633-1425

Mailing address

13336 S Baltimore Ave
Chicago, IL 60633-1425
Phone (773) 995-6300

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131028000031 IL Part B Supplier - Clinic/Group Practice 5991696643 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20240604000077 IL Part A Provider - Federally Qualified Health Center (FQHC) 5991696643 Practice locations: Chicago, IL

Federally qualified health center certification: CCN C41021

Legal name
TCA HEALTH INC NFP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 30, 2024
Last certification
Apr 30, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 2015 in IL
Enrollment address
13336 S Baltimore Ave
FL 1
Chicago, IL 60633-1425

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
Clinic in Altgeld Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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
Willie McShan Individual Corporate DirectorBoard Member Jan 1, 2010
Leonardo D. Gilbert Individual Corporate DirectorBoard Member Jan 1, 2010
Michael C. Fountain Individual Corporate DirectorBoard Member Jan 1, 2013
Edna Chima Individual Corporate Director Nov 16, 2015
Veronica Clarke Individual Corporate Officer Nov 16, 2015
Operational/Managerial Control Nov 16, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tca Health ChathamChicago, IL, CCN 781846 Federally qualified health center Operational/Managerial Control Nov 1, 2015

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1164149100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13336 S BALTIMORE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606331425",
            "telephone_number": "773-995-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13336 S BALTIMORE, 1ST FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606331425",
            "telephone_number": "773-995-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TCA HEALTH INC NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-20",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-995-1940"
    },
    "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.