NPIMap

Organization Active NPI

County of Lake

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
National Provider Identifier
1235453309
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNTY OF LAKE
Practice address
3010 Grand Ave
Waukegan, IL 60085-2321
Phone
(847) 377-8000
NPI assigned
Mar 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

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

Authorized official

Name
Sam Johnson
Title
Deputy Executive Director
Phone
(847) 377-8000

Specialties & licenses 1

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

Addresses

Primary practice location

3010 Grand Ave
Waukegan, IL 60085-2321

Mailing address

3010 Grand Ave
Waukegan, IL 60085-2321
Phone (847) 377-8000

Other names 1

  • Lake County Health Department and Community 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
O20040116000192 IL Part B Supplier - Clinic/Group Practice 7214838861 Receives reassigned benefits from 148 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waukegan, IL; Zion, IL; Vernon Hills, IL; Round Lake Park, IL; Round Lake Beach, IL; Round Lake, IL; Park City, IL; North Chicago, IL…
O20100622000318 IL Part A Provider - Federally Qualified Health Center (FQHC) 7214838861 Practice locations: Waukegan, IL

Federally qualified health center certification: CCN 141122

Legal name
COUNTY OF LAKE
Doing business as
LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 22, 2010
Last certification
Jun 22, 2010
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
3010 Grand Ave
Waukegan, IL 60085-2321

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Lake County Mental Heal T45 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

View all 42

Locations

3004 Grand Ave
Waukegan, IL 60085
Phone (847) 377-8120

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Natalie D Basgall Individual W-2 Managing EmployeeRevenue Cycle Manager Mar 24, 2025 5%
Andrea Cooper Individual Corporate DirectorDirector of Finance and Admin Cfo Jul 15, 2024
W-2 Managing EmployeeDirector of Finance and Admin Cfo Jul 15, 2024
Operational/Managerial ControlDirector of Finance and Admin Cfo Jul 15, 2024
County of Lake Organization, Waukegan, IL Operational/Managerial Control Mar 1, 2010

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
County of LakeRound Lake Beach, IL, CCN 141913 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 21, 2004
Lake County Health DepartmentNorth Chicago, IL, CCN 141911 Federally qualified health center Operational/Managerial Control Sep 13, 2004
Lake County Health Department and Community Health CenterWaukegan, IL, CCN 141910 Federally qualified health center Operational/Managerial Control May 31, 2000
Lake County Health Department and Community Health CenterZion, IL, CCN 141912 Federally qualified health center Operational/Managerial Control Dec 1, 2000
Lake County Health Department and Community Health CenterHighland Park, IL, CCN 141096 Federally qualified health center Operational/Managerial Control Jun 26, 2006
Lake County Health Department and Community Health CenterLibertyville, IL, CCN 781831 Federally qualified health center Operational/Managerial Control Dec 1, 2014

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1235453309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "DEPUTY EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "847-377-8000"
    },
    "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": "Lake County Health Department and Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.