NPIMap

Organization Active NPI

Community Health & Emergency Services, Inc.

Doing business as Cedar Court Clinic

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
National Provider Identifier
1316939929
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
Doing business as
Cedar Court Clinic
Practice address
1340 Cedar CT
Carbondale, IL 62901-5336
Phone
(618) 457-7821
Fax
(618) 529-3862
NPI assigned
Aug 19, 2005
Last updated
Aug 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Authorized official

Name
Mr. Frederick L Bernstein
Title
Ceo
Phone
(618) 457-0450

Specialties & licenses 1

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

Addresses

Primary practice location

1340 Cedar CT
Carbondale, IL 62901-5336

Mailing address

PO Box 3008
Carbondale, IL 62902-3008
Phone (618) 457-0450

Other names 1

  • Cedar Court Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070202000090 IL Part A Provider - Federally Qualified Health Center (FQHC) 0749194702 Practice locations: Carbondale, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316939929. Details of each certification follow.

Federally qualified health center certification: CCN 141894

Legal name
COMMUNITY HEALTH & EMERGENCY SERVICES INC
Doing business as
CEDAR COURT CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 20, 2000
Last certification
Jan 20, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 29, 1981 in IL
Enrollment address
1340 Cedar CT
Carbondale, IL 62901-5336

Other NPIs with the same Medicare PAC ID 6

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
14D0912873Cedar Court Clinic1340 Cedar Court, Carbondale, IL 62901Certificate of waiverAug 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Health Anesth18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

1340 Cedar Ct
Carbondale, IL 62901
Phone (618) 457-7821

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Katrina W Cerutti Individual Corporate OfficerBoard Member Nov 17, 2009
Josie Eason Individual Corporate OfficerBoard Member Jul 31, 2007
Elida Phifer Individual Corporate OfficerBoard Member Nov 9, 2004
Frederick L Bernstein Individual Corporate DirectorCeo Nov 17, 2006
W-2 Managing EmployeeCeo Jan 16, 2015
Heather Green Individual Corporate Officer Aug 25, 2016
Charles Soward Individual Corporate OfficerTreasurer Jul 1, 1996

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1316939929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3008",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023008",
            "telephone_number": "618-457-0450",
            "fax_number": "618-457-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CEDAR CT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015336",
            "telephone_number": "618-457-7821",
            "fax_number": "618-529-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH & EMERGENCY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "BERNSTEIN",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-457-0450",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "Cedar Court Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cedar Court Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.