NPIMap

Organization Active NPI

Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
National Provider Identifier
1346791167
Registry record updated Oct 17, 2016
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
1023 E Washington St
Springfield, IL 62703-1047
Phone
(217) 788-2300
Fax
(217) 788-2342
NPI assigned
Oct 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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

Authorized official

Name
Cindy Kavanagh
Title
Accountant
Phone
(217) 788-2300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1023 E Washington St
Springfield, IL 62703-1047

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161111001183 IL Part A Provider - Federally Qualified Health Center (FQHC) 3274445762 Practice locations: Springfield, IL

Federally qualified health center certification: CCN 781862

Legal name
CENTRAL COUNTIES HEALTH CENTERS, INC.
Doing business as
CENTRAL COUNTIES HEALTH CENTERS - HELPING HANDS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 11, 2016
Last certification
Nov 11, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1996 in IL
Enrollment address
2200 Shale St
Springfield, IL 62703

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

Other organizations with this tax ID 4

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

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 7%
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 DirectorDirector Jan 1, 2010 8%
Sam Gaines Individual Corporate DirectorDirector 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 4%
W-2 Managing EmployeeCoo Dec 20, 1999 4%
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 8%
Heather Burton Individual Corporate OfficerCeo Jun 30, 2014 4%
W-2 Managing EmployeeCeo Jun 30, 2014 4%

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": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1346791167",
    "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": "1023 E WASHINGTON ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031047",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "KAVANAGH",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "217-788-2300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.