PCC Community Wellness Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Oak Park, IL
NPI 1356061899 · NPPES record last updated Sep 2, 2022
Key facts
- NPI
- 1356061899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PCC COMMUNITY WELLNESS CENTER
- Practice address
- 3 Erie CT Ste 6160
Oak Park, IL 60302-2519 - Phone
- (708) 533-1537
- NPI assigned
- Sep 2, 2022
- Organization subpart
- No
Authorized official
- Name
- Toni Bush
- Title
- President and Ceo
- Phone
- (708) 524-7686
Owners & managing parties with NPI records 2
-
Janet Y Forbes, M.D.
-
Paul S Luning, MD
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 20
Practitioners 91
-
Mahnaz Jeelani Ali, D.O.
-
Alinaa Alsaud, PA-C
-
Yesenia Arce, M.D.
-
Cecelia B Bacom, CNM
-
Morgan Colleen Beatty, MD, MPH
-
Patricia Billingsley, RN, APN
-
Rachel Brdicka, FNP
-
Mary L Brown, APN
-
Mary Buswell, MD
-
Yolanda Cardenas, M.D.
-
Bianca Cervantes, LCPC
-
Peter M Chapman, LCSW
-
Robin Apri D'Aversa, DNP, CNM, APRN
-
Julene Davis, PMHNP
-
Megan K Dawson, APN
-
Natasha Diaz, MD
-
Michelle Doscas, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0879519 | PCC Burdick Family Health Center | Provider-performed microscopy | Aug 11, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Federally qualified health center certification: CCN C41051
- Legal name
- PCC COMMUNITY WELLNESS CENTER
- Doing business as
- PCC DR. BURDICK FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 22, 2025
- Last certification
- Sep 22, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1 Erie CT
Ste 6160
Oak Park, IL 60302-2510
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Sonia Taylor |
W-2 Managing Employee |
Jan 28, 2024 | 100% |
| Alyssa Sianghio |
Corporate Officer |
Apr 10, 2024 | 100% |
| W-2 Managing Employee | Apr 10, 2024 | 100% | |
| John McDonnell |
Corporate Director |
Jul 26, 2011 | |
| Patricia Ford |
Corporate Director |
Aug 25, 2009 | |
| Richard Ducatenzeller |
Corporate Director |
Jul 1, 2024 | |
| Christopher Barracks |
Corporate Director |
Jan 1, 2024 | |
| Ron Austin |
Corporate Director |
Jun 8, 2001 | |
| Nilsa Campos |
Corporate Officer |
Sep 1, 2021 | 100% |
| W-2 Managing Employee | Sep 1, 2021 | 100% | |
| Velda Brunner |
Corporate Director |
Nov 29, 2015 | |
| Hiren Patel |
Corporate Officer |
Sep 11, 2024 | 100% |
| W-2 Managing Employee | Sep 11, 2024 | 100% | |
| Janet Y Forbes |
Corporate Director |
Jul 1, 2023 | |
| Wrenetha Julion |
Corporate Director |
Jul 1, 2020 | |
| Sara Hogue |
Corporate Officer |
Jan 1, 2020 | 100% |
| W-2 Managing Employee | Jan 1, 2020 | 100% | |
| Melissa Kirk |
Corporate Director |
Jul 1, 2024 | |
| Paul Luning |
Corporate Officer |
Sep 17, 2007 | 100% |
| Kenneth M Blair |
Corporate Director |
Jul 31, 1992 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| PCC Dr Tong Health Center |
Federally qualified health center | Other (100%) | Sep 15, 2004 |
| PCC Walk-in Wellness Center at West Suburban Medical Center |
Federally qualified health center | Other (100%) | Sep 15, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251022002726 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 1557270139 | Practice locations: Oak Park, IL |
National Provider Directory
- Tax ID family
- PCC Community Wellness Ctr
Locations
3 Erie Ct
Ste 6160
Oak Park, IL 60302
Phone (708) 434-4007
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
3 Erie CT Ste 6160
Oak Park, IL 60302-2519
Mailing address
3 Erie CT Ste 6160
Oak Park, IL 60302-2519
Other names
- PCC Dr. Burdick Family Health Center
Other providers in Oak Park, IL
- Dina Pavilonis
- Marcia M Pavlou
- Brandon Pavon
- Paxxon Healthcare Services LLC
- PCC Community Wellness Center
- PCC Community Wellness Center
- PCC Community Wellness Center
- PCC Community Wellness Center
- PCC Community Wellness Center
- PCC Community Wellness Center
All providers in Oak Park, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.