NPIMap

Organization Active NPI

Progressive Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
National Provider Identifier
1376851311
Registry record updated Jan 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Practice address
1452 N 7TH St
2ND Floor
Milwaukee, WI 53205-2301
Phone
(414) 935-8000
NPI assigned
Sep 23, 2010
Last updated
Jan 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2017

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

Authorized official

Name
Mrs. Candice Cole
Title
Cfo
Phone
(414) 935-8000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician Assistant 363A00000X
Clinical Social Worker 1041C0700X
Adult Medicine Physician 207QA0505X

Addresses

Primary practice location

1452 N 7TH St
2ND Floor
Milwaukee, WI 53205-2301

Mailing address

PO Box 080257
Milwaukee, WI 53208-8004
Phone (414) 935-8000

Other identifiers 1

IdentifierTypeStateIssuer
32957400MedicaidWI

Other names 1

  • Hillside Family Practice Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000358 WI Part B Supplier - Clinic/Group Practice 2466366059 Receives reassigned benefits from 59 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milwaukee, WI
O20101124000978 WI Part A Provider - Federally Qualified Health Center (FQHC) 2466366059 Practice locations: Milwaukee, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376851311. Details of each certification follow.

Federally qualified health center certification: CCN 521838

Legal name
PROGRESSIVE COMMUNITY HEALTH CENTERS INC
Doing business as
HILLSIDE FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 26, 2010
Last certification
Nov 26, 2010
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 14, 2011 in WI
Enrollment address
1452 N 7TH St
Milwaukee, WI 53205-2301
Related CCNs
521821

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

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
52D2321457Progressive Community Health Centers, Inc1452 North 7TH St, 2ND Floor, Milwaukee, WI 53205Certificate of waiverApr 3, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jennifer a Sevenich Individual W-2 Managing EmployeeCeo Mar 14, 2005
Janice Harrell Individual Corporate Director Aug 18, 2015
Barbara Zak Individual W-2 Managing EmployeeCoo Mar 6, 2018
John F Sieger Individual Corporate Director Sep 8, 2011
Darcy Alatalo Individual Corporate OfficerBoard Treasurer Apr 24, 2018
Dianne Bolden Individual Corporate OfficerBoard Secretary Aug 28, 2018
Albert Cooper Individual Corporate Director Oct 25, 2016
Diane Chamness Individual Corporate OfficerVice Chair Aug 28, 2018
John a Grandberry Individual Corporate OfficerChair Aug 28, 2018
Candice L Cole Individual W-2 Managing EmployeeCfo Aug 9, 2014
Allison M Kos Individual W-2 Managing EmployeeCmo Apr 4, 2011
Evan C Goyke Individual Corporate Director May 20, 2014
Heather Saucedo Individual Corporate DirectorDirector Oct 19, 2018

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 3

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": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485302400000",
    "number": "1376851311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 080257",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532088004",
            "telephone_number": "414-935-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1452 N 7TH ST",
            "address_2": "2ND FLOOR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532052301",
            "telephone_number": "414-935-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2017-01-25",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "414-935-8000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32957400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hillside Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.