Central Counties Health Centers, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CENTRAL COUNTIES HEALTH CENTERS, INC.

Practice address

1440 W Walnut St
Suite 2
Jacksonville, IL 62650-1143

Phone

(217) 788-2300

Fax

(217) 788-2342

NPI assigned

May 12, 2016

Last updated

May 19, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

CENTRAL COUNTIES HEALTH CENTERS, INC.As reported in NPPES

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

Authorized official

Name

Cindy Kavanagh

Title

Accountant

Phone

(217) 788-2300

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205282936. Details of each certification follow.

• CCN 781853 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 781853

Legal name

CENTRAL COUNTIES HEALTH CENTERS INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 21, 2016

Last certification

Jun 21, 2016

Ownership / control type

For profit – corporation

Facility address

1440 W Walnut Street Suite 2
Jacksonville, IL 62650

Part of

Central Co HLTH Ctr Inc

Locations

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1205282936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2239 E COOK ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031944",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 W WALNUT ST",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501143",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "enumeration_date": "2016-05-12",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "KAVANAGH",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "217-788-2300"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.