NPIMap

Organization Active NPI

Chestnut Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Granite City, IL
National Provider Identifier
1326417080
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
Practice address
50 Northgate Industrial Dr
Granite City, IL 62040-6805
Phone
(618) 512-1919
Fax
(618) 512-1920
NPI assigned
Sep 23, 2015
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
Manged Care Supervisor
Phone
(888) 924-3786

Specialties & licenses 1

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

Addresses

Primary practice location

50 Northgate Industrial Dr
Granite City, IL 62040-6805

Mailing address

1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Other names 1

  • Chestnut Family Health Center Granite City Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160919001079 IL Part A Provider - Federally Qualified Health Center (FQHC) 1052393063 Practice locations: Granite City, IL

Federally qualified health center certification: CCN 781858

Legal name
CHESTNUT HEALTH SYSTEMS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 19, 2016
Last certification
Sep 19, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 28, 1970 in IL
Enrollment address
50 Northgate Industrial Dr
Granite City, IL 62040-6805

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Chestnut Health Systems Inc44 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 12

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
Al Bowman Individual Corporate DirectorBoard Member Sep 1, 2003
Melissa Woodbury Individual Corporate OfficerCfo Oct 1, 2025
Laura S Haas Individual Corporate DirectorBoard Member Jan 1, 2016
Judy L Neubrander Individual Corporate DirectorBoard Member Mar 1, 2018
Eliazar Mendiola Individual Corporate DirectorBoard Member Jan 1, 2016
Mary Ann Ann Webb Individual Corporate DirectorBoard Vice Chairperson May 1, 2008
James F Foley Individual Corporate DirectorBoard Member Jan 1, 2016
Patrick Busch Individual Corporate DirectorBoard Member Jan 1, 2018
Don Hammer Individual Corporate DirectorBoard Member Aug 1, 2007
Dennis Wilmsmeyer Individual Corporate Director May 1, 2018

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1326417080",
    "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": "50 NORTHGATE INDUSTRIAL DR",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620406805",
            "telephone_number": "618-512-1919",
            "fax_number": "618-512-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "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": "MANGED CARE SUPERVISOR",
        "authorized_official_telephone_number": "888-924-3786"
    },
    "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": "Chestnut Family Health Center Granite City",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Chestnut Family Health Center Granite City",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.