NPIMap

Organization Active NPI

Howard Brown Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1306048632
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HOWARD BROWN HEALTH CENTER
Practice address
4025 N Sheridan Rd
Chicago, IL 60613
Phone
(773) 388-1600
Fax
(773) 388-8936
NPI assigned
May 31, 2007
Last updated
Apr 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Authorized official

Name
Ms. Burgundy Johnson
Title
Credentialing
Phone
(872) 629-3491

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Community/Behavioral Health Agency 251S00000X 30411 IL

Addresses

Primary practice location

4025 N Sheridan Rd
Chicago, IL 60613

Mailing address

4025 N Sheridan Rd
Chicago, IL 60613-2010
Phone (773) 388-1600

Other identifiers 1

IdentifierTypeStateIssuer
30411OtherILSTATE LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040325000526 IL Part B Supplier - Clinic/Group Practice 1052203155 Receives reassigned benefits from 165 practitioners
7 other NPIs on this enrollment
Practice locations: Chicago, IL
O20090805000459 IL Part A Provider - Federally Qualified Health Center (FQHC) 1052203155 Practice locations: Chicago, IL
O20091030000162 IL Part A Provider - Federally Qualified Health Center (FQHC) 1052203155 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1306048632. Details of each certification follow.

Federally qualified health center certification: CCN 141101

Legal name
HOWARD BROWN HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1974 in IL
Enrollment address
4025 N Sheridan Rd
Chicago, IL 60613-2010

Federally qualified health center certification: CCN 141108

Legal name
HOWARD BROWN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 30, 2009
Last certification
Oct 30, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1974 in IL
Enrollment address
3501 N Halsted St
Chicago, IL 60657-1832

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Magda Houlberg Individual Corporate OfficerHLTH Ctr Operations & Coo Oct 1, 2012
Operational/Managerial ControlMedical Director Jan 19, 2011
Corporate DirectorIntermin Ceo Apr 1, 2014
Emily E Byrne-Driver Individual Corporate OfficerExec Vice Chair Jul 1, 2014
Dwight M Alden Individual Corporate OfficerChairperson of the Board of Dir. Sep 1, 2012
Corporate OfficerChair Board Member Jul 1, 2011
Ryan Garrison Individual Corporate Director Jul 1, 2016
David E Munar Individual Corporate OfficerCeo Apr 14, 2014
Operational/Managerial ControlPresident / Ceo Apr 1, 2014 100%
Corporate OfficerPresident/ Ceo Apr 4, 2014
Bethany M Pagels-Minor Individual Corporate OfficerVice Chair at Large Jul 1, 2015
W Robert Schultz Individual Corporate Director Jul 1, 2014
Fawna MJ Stockwell Individual Corporate Director Jul 1, 2015
Rebecca E Rowland Individual Corporate OfficerVice Chair at Large Jul 1, 2014
Contracted Managing EmployeeBoard Director Jul 1, 2014
Jeffrey P Todd Individual Corporate OfficerVice Chair/Acting Secrety of Bod Jun 27, 2011
Corporate DirectorVice Chair Board Member Mar 28, 2011
Kinley G Preston Individual Corporate Director Jul 1, 2016
Ryan D Siemers Individual Corporate DirectorBoard Member Sep 1, 2012
Garrett M Taliaferro Individual Corporate Director Jul 1, 2015
Nathaniel C Thomas Individual Corporate Director Jul 1, 2015
Sharon M Roberson Individual Corporate Director Jul 1, 2016
Oscar I Zambrano Individual Corporate Director Jul 1, 2014
Miguel a Torres Individual Corporate Director Jul 1, 2014
Mario Treto Individual Corporate OfficerVice Chair Secretary Jul 1, 2014
Mark L Hawkins Individual Corporate DirectorBoard Member Sep 1, 2012
Corporate OfficerBoard Member Sep 1, 2012
Rogelio R Fierro Individual Corporate Director Jul 1, 2014
Vanessa Ann Griggley-Owens Individual Corporate OfficerBoard Member Oct 18, 2013
Matthew J Nielson Individual Corporate DirectorBoard Member Jun 1, 2007
Randall B Mims Individual Corporate OfficerVice Chair and Secretary of Boar Sep 1, 2014
Francis L Buttitta Individual Corporate OfficerBoard Member Jun 29, 2010
Robert Fortney Individual Corporate OfficerBoard Member Aug 28, 2013
John McElwee Individual Corporate OfficerChief Financial Officer Sep 1, 2017

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 237

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 237

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1306048632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132010",
            "telephone_number": "773-388-1600",
            "fax_number": "773-388-1602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "773-388-1600",
            "fax_number": "773-388-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOWARD BROWN HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BURGUNDY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "872-629-3491",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "30411",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "30411",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.