NPIMap

Organization Active NPI

Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1396986147
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LAWNDALE CHRISTIAN HEALTH CENTER
Practice address
5122 S Archer Ave
Chicago, IL 60632-4508
Phone
(872) 588-3000
NPI assigned
Mar 7, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
Karen Renee Johnson
Title
Asst Dir of Patient Accounting
Phone
(872) 588-3062

Specialties & licenses 1

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

Addresses

Primary practice location

5122 S Archer Ave
Chicago, IL 60632-4508

Mailing address

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone (872) 588-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090916000581 IL Part A Provider - Federally Qualified Health Center (FQHC) 2264336346 Practice locations: Chicago, IL

Federally qualified health center certification: CCN 141107

Legal name
LAWNDALE CHRISTIAN HEALTH CENTER
Doing business as
LAWNDALE CHRISTIAN HEALTH CENTER ARCHER AVENUE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 21, 2009
Last certification
Sep 21, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1984 in IL
Enrollment address
5122S Archer Ave
Chicago, IL 60632-4508

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Lawndale Christian Health10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Isabel Martin Individual Corporate Director Apr 1, 2022
Lawndale Christian Health Center Organization, Chicago, IL Operational/Managerial Control Jul 1, 2009
Audrey G Brewer Individual Corporate OfficerVice Chair Apr 1, 2022
Karen Johnson Individual W-2 Managing EmployeeAssistant Dir of Patient Accounting Oct 11, 1994
Chelsea Johnson Individual Corporate OfficerBoard Chair Mar 1, 2022
Thomas Worthy Individual Corporate Director Mar 1, 2022
Christopher Dons Individual Corporate OfficerChief Financial Officer Oct 1, 2013
Corporate Director Jul 1, 2009
Shonte Little Individual Corporate Director Apr 1, 2023
Jorge Rubalcava Individual Corporate OfficerTreasurer Jul 1, 2023
Jonathan Brooks Individual Corporate Director Oct 1, 2022
James Brooks Individual Corporate DirectorCeo Jan 3, 2022

Owners & managing parties with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 124

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

View all 124

NPI Registry JSON

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

{
    "created_epoch": "1236384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1396986147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5122 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324508",
            "telephone_number": "872-588-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWNDALE CHRISTIAN HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-07",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "ASST DIR OF PATIENT ACCOUNTING",
        "authorized_official_telephone_number": "872-588-3062"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.