NPIMap

Organization Active NPI

Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
National Provider Identifier
1225588387
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL COUNTIES HEALTH CENTERS, INC.
Practice address
800 E Carpenter St
Springfield, IL 62702-5324
Phone
(217) 788-2300
NPI assigned
Oct 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

800 E Carpenter St
Springfield, IL 62702-5324

Mailing address

2239 E Cook St
Springfield, IL 62703-1944
Phone (217) 788-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161026002909 IL Part A Provider - Federally Qualified Health Center (FQHC) 3274445762 Practice locations: Springfield, IL

Federally qualified health center certification: CCN 781859

Legal name
CENTRAL COUNTIES HEALTH CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 28, 2016
Last certification
Oct 28, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1996 in IL
Enrollment address
700 N 7TH St
Springfield, IL 62702-6352

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Central Co HLTH Ctr Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Misty Hall Individual Corporate DirectorDirector Dec 17, 2019 7%
Sandra Yard Individual Corporate DirectorDirector Aug 21, 2017 7%
Julie Ann Janssen Individual Corporate DirectorChairman of the Board Dec 11, 2013 8%
Patricia Flores Aguirre Individual Corporate Director Mar 26, 2024
James T Greenwald Individual Corporate DirectorSecretary Jan 1, 2010 8%
Sam Gaines Individual Corporate DirectorTreasurer Jan 1, 2010 8%
Michael Myles Individual Corporate DirectorDirector Jan 1, 2010 8%
Racine Freeman Individual Corporate DirectorDirector Jan 1, 2010 8%
Elaina White Individual Corporate Director Mar 26, 2024
Brad Buzzard Individual Corporate OfficerCoo Dec 20, 1999 8%
W-2 Managing EmployeeCoo Dec 20, 1999
Angel R Macgibbon Individual Corporate OfficerCfo Jul 27, 2020 8%
W-2 Managing EmployeeCfo Jul 27, 2020
Judy Henderson Individual Corporate DirectorDirector Apr 8, 2014 8%
Lois Davis Individual Corporate DirectorDirector Nov 26, 2019 7%
Heather Burton Individual Corporate OfficerCeo Jun 30, 2014 8%
W-2 Managing EmployeeCeo Jun 30, 2014

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1225588387",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E CARPENTER ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025324",
            "telephone_number": "217-788-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "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": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Springfield, IL

Sources for this page

Verify at the official NPI Registry.