NPIMap

Organization Active NPI

Chestnut Health Systems Inc.

Doing business as Chestnut Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Bloomington, IL
National Provider Identifier
1225740756
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHESTNUT HEALTH SYSTEMS INC.
Doing business as
Chestnut Family Health Center
Practice address
1003 Martin Luther King Dr
Bloomington, IL 61701-1429
Phone
(888) 924-3678
NPI assigned
Dec 15, 2022
Last updated
Mar 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Megan Marie Taylor
Title
Managed Care Supervisor
Phone
(888) 924-3786

Specialties & licenses 1

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

Addresses

Primary practice location

1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Mailing address

1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Other names 1

  • Chestnut Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230302001846 IL Part A Provider - Federally Qualified Health Center (FQHC) 1052393063 Practice locations: Bloomington, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225740756. Details of each certification follow.

Federally qualified health center certification: CCN 781099

Legal name
CHESTNUT HEALTH SYSTEMS INC
Doing business as
CHESTNUT FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 20, 2022
Last certification
Dec 20, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2017 in IL
Enrollment address
1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Other NPIs with the same Medicare PAC ID 5

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

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
14D2102459Chestnut Family HLTH Ctr Granite City1003 Martin Luther King Dr, Bloomington, IL 61701Certificate of waiverSep 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Chestnut Health Systems44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Victor Armstrong Individual Corporate DirectorBoard Member Feb 1, 2001
Puneet Leekha Individual Corporate OfficerCeo Oct 1, 2025
W-2 Managing EmployeeCeo Oct 1, 2025
Melissa Woodbury Individual Corporate OfficerCfo Oct 1, 2025
Laura S Haas Individual Corporate DirectorBoard Member May 1, 2007
Judy L Neubrander Individual Corporate DirectorBoard Member Dec 1, 2017
Eliazar Mendiola Individual Corporate DirectorBoard Member Dec 1, 2015
Mary Ann Ann Webb Individual Corporate DirectorBoard Member May 1, 2008
James F Foley Individual Corporate DirectorBoard Member Dec 1, 2014
George Wood Individual Corporate DirectorBoard Member Jan 1, 2019
Patrick Busch Individual Corporate DirectorBoard Member Jan 1, 2018
Don Hammer Individual Corporate DirectorBoard Member Nov 1, 1999
Dennis Wilmsmeyer Individual Corporate DirectorBoard Member May 1, 2018
Angela Allen Individual Corporate DirectorBoard Member Feb 1, 2019

NPI Registry JSON

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1225740756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429",
            "telephone_number": "888-924-3678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT HEALTH SYSTEMS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGED CARE SUPERVISOR",
        "authorized_official_telephone_number": "888-924-3786"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chestnut Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chestnut Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.