NPIMap

Organization Active NPI

Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
National Provider Identifier
1245759273
Registry record updated Sep 11, 2017
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
120 N 11TH St
Springfield, IL 62703-1002
Phone
(217) 788-2300
NPI assigned
Sep 11, 2017
Last updated
Sep 11, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRAL COUNTIES HEALTH CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2017

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

Authorized official

Name
Jason Jones
Title
Cfo
Phone
(217) 788-2300

Specialties & licenses 1

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

Addresses

Primary practice location

120 N 11TH St
Springfield, IL 62703-1002

Mailing address

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

Other names 1

  • Central Counties Health Centers, Inc. - Family Guidance Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171024003448 IL Part A Provider - Federally Qualified Health Center (FQHC) 3274445762 Practice locations: Springfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245759273. Details of each certification follow.

Federally qualified health center certification: CCN 781893

Legal name
CENTRAL COUNTIES HEALTH CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 24, 2017
Last certification
Oct 24, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1996 in IL
Enrollment address
120 N 11TH St
Springfield, IL 62703-1002

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
Part of
Central Co HLTH Ctr Inc

Other organizations with this tax ID 4

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

Locations

120 N 11th St
Springfield, IL 62703
Phone (217) 544-9858

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 8%
Sandra Yard Individual Corporate DirectorDirector Aug 21, 2017 7%
Julie Ann Janssen Individual Corporate OfficerChairman Dec 11, 2013 8%
Patricia Flores Aguirre Individual Corporate Director Mar 26, 2024
James T Greenwald Individual Corporate Director 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 7%
Lois Davis Individual Corporate DirectorDirector Nov 26, 2019 7%
Heather Burton Individual Corporate OfficerCeo Jul 27, 2020 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": "1505088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505088000000",
    "number": "1245759273",
    "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": "217-788-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N 11TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031002",
            "telephone_number": "217-788-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "enumeration_date": "2017-09-11",
        "last_updated": "2017-09-11",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "217-788-2300"
    },
    "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": "Central Counties Health Centers, Inc. - Family Guidance Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.