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PCC Community Wellness Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago, IL

NPI 1164628012 · NPPES record last updated Mar 5, 2021

Key facts

NPI
1164628012
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
PCC COMMUNITY WELLNESS CENTER
Practice address
2434 W Division St
Chicago, IL 60622-2942
Phone
(773) 292-8300
Fax
(708) 292-2601
NPI assigned
Jun 26, 2007
Organization subpart
No

Authorized official

Name
Mr. Robert J Urso
Title
President - Chief Executive Officer
Phone
(708) 383-9786

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 16

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

Corporate family (same tax ID) 20

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

Practitioners 91

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

View all 91

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1079152PCC West Town Family Health Center
2434 W Division Street, Chicago, IL 60622		Provider-performed microscopyJan 7, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Federally qualified health center certification: CCN 141092

Legal name
PCC COMMUNITY WELLNESS CENTER
Doing business as
PCC WEST TOWN FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 12, 2009
Last certification
Jan 12, 2009
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Apr 14, 1992 in IL
Enrollment address
2434 W Division St
Chicago, IL 60622-2942

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
Sonia Taylor
Individual 		Corporate Director
Senior Director of Finance		 Jan 28, 2024
W-2 Managing Employee Jan 28, 2024
Alyssa Sianghio
Individual 		Corporate Officer
President and Ceo		 Apr 10, 2024 100%
W-2 Managing Employee Apr 10, 2024 100%
John McDonnell
Individual 		Corporate Director
Board Member		 Jul 26, 2011
Patricia Ford
Individual 		Corporate Director
Board Member		 Aug 25, 2009
Richard Ducatenzeller
Individual 		Corporate Director
Board Member		 Jul 1, 2024
Christopher Barracks
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Ron Austin
Individual 		Corporate Director
Board Member		 Jun 8, 2001
Nilsa Campos
Individual 		Corporate Officer
Chief Operations Officer		 Sep 1, 2021 100%
W-2 Managing Employee Sep 1, 2021 100%
Velda Brunner
Individual 		Corporate Director
Board Member		 Nov 29, 2015
Hiren Patel
Individual 		Corporate Officer
Chief Financial Officer		 Sep 11, 2024 100%
W-2 Managing Employee Sep 11, 2024 100%
Janet Y Forbes
Individual 		Corporate Director
Board Member		 Jul 1, 2023
Wrenetha Julion
Individual 		Corporate Director
Board Member		 Jul 1, 2020
Sara Hogue
Individual 		Corporate Officer
Chief Quality Improvement Officer		 Jan 1, 2020 100%
W-2 Managing Employee Jan 1, 2020 100%
Melissa Kirk
Individual 		Corporate Director
Board Member		 Jul 1, 2024
Paul Luning
Individual 		Corporate Officer
Chief Medical Officer		 Sep 17, 2007 100%
W-2 Managing Employee
Chief Medical Officer		 Sep 17, 2007 100%
Kenneth M Blair
Individual 		Corporate Director
Board Treasurer		 Jul 31, 1992

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
PCC Dr Tong Health Center
Oak Park, IL · CCN 141034		 Federally qualified health center Other (100%) Sep 15, 2004
PCC Walk-in Wellness Center at West Suburban Medical Center
Oak Park, IL · CCN 781802		 Federally qualified health center Other (100%) Sep 15, 2004

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081120000723 IL Part a Provider - Federally Qualified Health Center (FQHC) 1557270139 Practice locations: Chicago, IL

National Provider Directory

Tax ID family
PCC Community Wellness Ctr (21 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

2434 W Division St
Chicago, IL 60622-2942

Mailing address

2434 W Division St
Chicago, IL 60622-2942
Phone (773) 292-8300

Other names

  • PCC West Town Family Health Center Doing business as

Other providers in Chicago, IL

All providers in Chicago, IL · Federally Qualified Health Center (FQHC) in Illinois

Sources for this page

Verify at the official NPI Registry.