NPIMap

Organization Active NPI

Erie Family Health Center Inc.

Doing business as Erie Amundsen School Base Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1164713129
Registry record updated Apr 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
261QF0400X Issued in IL
Legal business name
ERIE FAMILY HEALTH CENTER INC.
Doing business as
Erie Amundsen School Base Health Center
Practice address
5110 N Damen Ave
Chicago, IL 60625-1317
Phone
(312) 666-3494
NPI assigned
Apr 26, 2011
Last updated
Apr 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2011

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

Authorized official

Name
Miss Gabriela Norena
Title
Patient Account Supervisor
Phone
(312) 432-7444

Specialties & licenses 1

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

Addresses

Primary practice location

5110 N Damen Ave
Chicago, IL 60625-1317

Mailing address

1701 W Superior St
Chicago, IL 60622-5646
Phone (312) 666-3494

Other identifiers 2

IdentifierTypeStateIssuer
1616827OtherILBLUE CROSS BLUE SHIELD
748480OtherILMEDICARE

Other names 1

  • Erie Amundsen School Base Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000689 IL Part B Supplier - Clinic/Group Practice 9537050422 Receives reassigned benefits from 396 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Evanston, IL; Lake Forest, IL; Waukegan, IL
O20110829000135 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537050422 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164713129. Details of each certification follow.

Federally qualified health center certification: CCN 141146

Legal name
ERIE FAMILY HEALTH CENTER, INC
Doing business as
ERIE AMUNDSEN SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 29, 2011
Last certification
Sep 29, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 24, 1976 in IL
Enrollment address
5110 N Damen Ave
Chicago, IL 60625-1317

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 12

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0918524Erie Amundsen School Base Health Ctr D/B/a5110 N Damen Ave, Chicago, IL 60625Provider-performed microscopyAug 12, 2026

National Provider Directory

National Provider Directory
Tax ID family
Erie Family Health Center18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

5110 N Damen Ave
Chicago, IL 60625
Phone (773) 275-1358

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Celeste Castillo Individual Corporate OfficerSecretary Dec 1, 2007
Brian Marsella Individual Corporate DirectorBoard Chair Aug 1, 2007
Lee Francis Individual Corporate OfficerPresident and Ceo Jul 1, 2008
Stephanie Smith Individual Corporate OfficerCfo Oct 13, 2025
Operational/Managerial ControlCfo Oct 13, 2025
Caroline M Hoke Individual Corporate OfficerChief Clinical Officer Mar 6, 2018
William Kistner Individual Corporate DirectorBoard Treasurer Jul 1, 2002
Mychel Owens Individual W-2 Managing EmployeeManaged Care Manager Oct 22, 2022
Amy Valukas Individual Corporate OfficerCoo Jul 3, 2016
Carolyn a Dickens Individual Corporate DirectorVice Chair Nov 1, 2007
Eric Mayeda Individual Corporate DirectorDirector Sep 15, 2004

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303776000000",
    "number": "1164713129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-666-3494",
            "fax_number": "312-666-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5110 N DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606251317",
            "telephone_number": "312-666-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE FAMILY HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-26",
        "last_updated": "2011-04-26",
        "status": "A",
        "authorized_official_last_name": "NORENA",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "PATIENT ACCOUNT SUPERVISOR",
        "authorized_official_telephone_number": "312-432-7444",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": "261QF0400X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1616827",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "748480",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Erie Amundsen School Base Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.