NPIMap

Organization Active NPI

Tca Health Inc NFP

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1184757353
Registry record updated Oct 16, 2019
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
1029 E 130TH St
Chicago, IL 60628-6908
Phone
(773) 995-6300
Fax
(773) 995-7985
NPI assigned
Mar 14, 2007
Last updated
Oct 16, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
TCA HEALTH INC NFPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2019

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

Authorized official

Name
Mrs. Veronica E Clarke
Title
Ceo
Phone
(773) 995-6300

Specialties & licenses 1

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

Addresses

Primary practice location

1029 E 130TH St
Chicago, IL 60628-6908

Mailing address

1029 E 130TH St
Chicago, IL 60628-6908
Phone (773) 995-6300

Other names 1

  • The Clinic in Altgeld Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322001893 IL Part A Provider - Federally Qualified Health Center (FQHC) 5991696643 Practice locations: Chicago, IL
O20131028000031 IL Part B Supplier - Clinic/Group Practice 5991696643 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184757353. Details of each certification follow.

Federally qualified health center certification: CCN 141855

Legal name
TCA HEALTH INC NFP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1993
Last certification
Oct 1, 1993
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1029 E 130TH St
Chicago, IL 60628-6908

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
Part of
Tca Health Inc Altgeld

Locations

13100 S Doty Ave
Rm 136
Chicago, IL 60827

13336 S Baltimore Ave
Chicago, IL 60633
Phone (312) 262-6768

13336 S Baltimore Ave
Ste 1
Chicago, IL 60633

8425 S Cottage Grove Ave
#1029E
Chicago, IL 60619

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Chioma Ochibutor Individual Corporate DirectorBoard Member Jul 8, 2005
Willie McShan Individual Corporate DirectorBoard Member May 1, 2003
Colin Relphorde Individual Corporate DirectorBoard Member Dec 1, 2005
Leonardo D. Gilbert Individual Corporate DirectorBoard Member Mar 1, 2010
Michael C. Fountain Individual Corporate OfficerBoard Member Sep 1, 2013
Corporate DirectorBoard Member Sep 1, 2013
Patricia Rayborn Individual Corporate DirectorBoard Member Nov 1, 2009
Edna Chima Individual Corporate Officer Jan 25, 2011
Corporate DirectorVice Chairman Jan 25, 2011
Elizabeth Steward Individual Corporate Officer Jan 25, 2011
Corporate DirectorSecretary Jan 25, 2011
Randall Caldwell Individual Corporate Officer Jan 25, 2011
Corporate DirectorChairman of the Board Jan 25, 2011
Veronica Clarke Individual Corporate Officer Nov 16, 2015
Corporate Director Nov 16, 2015
W-2 Managing EmployeeCeo Jan 1, 2012
Operational/Managerial ControlCeo Jan 1, 2012 100%
Donna M Gayden Individual Corporate OfficerBoard Member Jan 25, 2011
Corporate DirectorTreasurer Jan 25, 2011

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.

  • Tca Health Inc NFP

    dba Tca Health Chatham

    • Federally Qualified Health Center (FQHC)
    • Chicago, IL
    • NPI 1578936696

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571184000000",
    "number": "1184757353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 E 130TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606286908",
            "telephone_number": "773-995-6300",
            "fax_number": "773-995-7985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 E 130TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606286908",
            "telephone_number": "773-995-6300",
            "fax_number": "773-995-7985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TCA HEALTH INC NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TCA HEALTH INC NFP",
        "enumeration_date": "2007-03-14",
        "last_updated": "2019-10-16",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-995-6300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Clinic in Altgeld",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "The Clinic in Altgeld",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.