NPIMap

Organization Active NPI

Erie Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1396181590
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ERIE FAMILY HEALTH CENTER INC
Practice address
5215 N California Ave Ste F700
Chicago, IL 60625-7014
Phone
(312) 666-3494
Fax
(312) 666-0610
NPI assigned
May 14, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mrs. Gabriela Norena
Title
Billing Manager
Phone
(312) 432-7444

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 12

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 17

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

View all 17

Practitioners 151

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

View all 151

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
14D2056402Erie Foster Ave Health Center5215 N California - 7TH FL, Chicago, IL 60625Provider-performed microscopyMar 25, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000689 IL Part B Supplier - Clinic/Group Practice 9537050422 Receives reassigned benefits from 396 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Evanston, IL; Lake Forest, IL; Waukegan, IL
O20130619000005 IL Part a Provider - Federally Qualified Health Center (FQHC) 9537050422 Practice locations: Chicago, IL

Federally qualified health center certification: CCN 141199

Medicare enrollment files
Legal name
ERIE FAMILY HEALTH CENTER, INC
Doing business as
ERIE FOSTER AVENUE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2013
Last certification
Aug 6, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1970 in IL
Enrollment address
5215 N California Ave
Ste F700
Chicago, IL 60625-8562

All disclosed owners & managing parties 10

Medicare enrollment files

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

NameRoleSinceShare
Celeste Castillo Individual Corporate DirectorSecretary Dec 1, 2007
Brian Marsella Individual Corporate DirectorBoard Chair Aug 1, 2007
Lee Francis Individual Corporate OfficerPresident and Ceo Jul 1, 2013
Stephanie Smith Individual Corporate OfficerCfo Oct 13, 2025
Operational/Managerial ControlCfo Oct 13, 2025
Caroline M Hoke Individual Corporate OfficerChief Clinical Officer Mar 6, 2018
William Kistner Individual Corporate DirectorTreasurer Jul 1, 2002
Mychel Owens Individual W-2 Managing EmployeeManaged Care Manager Oct 22, 2022
Amy Valukas Individual Corporate OfficerCoo Jul 3, 2016
Carolyn a Dickens Individual Corporate OfficerVice Chair Nov 1, 2017
Eric Mayeda Individual Corporate DirectorDirector Sep 15, 2004

National Provider Directory

National Provider Directory
Tax ID family
Erie Family Health Center (18 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

5215 N California Ave Ste F700
Chicago, IL 60625-7014

Mailing address

5215 N California Ave Ste F700
Chicago, IL 60625-7014
Phone (312) 666-3494

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
1616827OtherILBLUE CROSS BLUE SHIELD
748480OtherILMEDICARE PART B

Other names 1

NPPES NPI Registry
  • Erie Foster Avenue Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 14, 2013.

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1396181590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 N CALIFORNIA AVE STE F700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606257014",
            "telephone_number": "312-666-3494",
            "fax_number": "312-666-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N CALIFORNIA AVE STE F700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606257014",
            "telephone_number": "312-666-3494",
            "fax_number": "312-666-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-14",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "NORENA",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "312-432-7444",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1616827",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "748480",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Erie Foster Avenue Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.