NPIMap

Organization Active NPI

Grand Prairie Services

  • Federally Qualified Health Center (FQHC)
  • Chicago Heights, IL
National Provider Identifier
1447723564
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRAND PRAIRIE SERVICES
Practice address
450 W 14TH St
Chicago Heights, IL 60411-2463
Phone
(708) 985-3040
Fax
(708) 474-8144
NPI assigned
Jan 11, 2019
Last updated
Nov 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GRAND PRAIRIE SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Authorized official

Name
Sharronne WardNPI 1902123516
Title
President and Ceo
Phone
(708) 444-1012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

450 W 14TH St
Chicago Heights, IL 60411-2463

Mailing address

17746 Oak Park Ave
Tinley Park, IL 60477-3936
Phone (708) 444-1012

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041116000208 IL Part B Supplier - Clinic/Group Practice 7517876691 Receives reassigned benefits from 8 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bradley, IL; Tinley Park, IL; Steger, IL; South Holland, IL; Park Forest, IL; Midlothian, IL; Matteson, IL; Flossmoor, IL…
O20190618000620 IL Part A Provider - Federally Qualified Health Center (FQHC) 7517876691 Practice locations: Chicago Heights, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447723564. Details of each certification follow.

Federally qualified health center certification: CCN 781926

Legal name
GRAND PRAIRIE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 18, 2019
Last certification
Jun 18, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 10, 1956 in IL
Enrollment address
450 W 14TH St
Chicago Heights, IL 60411-2463

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Grand Prairie Services21 organizations share this tax ID, including this one
Part of
Grand Prairie Services

Other organizations with this tax ID 20

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

View all 20

Locations

1240 Ashland Ave
Chicago Heights, IL 60411
Phone (708) 755-2250

19530 Governors Hwy
Flossmoor, IL 60422
Phone (708) 799-2200

15406 Lexington Ave
Harvey, IL 60426
Phone (708) 596-5900

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Deborah White Individual Corporate Director Sep 1, 2016
Billie Williams Individual Corporate Director Sep 1, 2016
Sharronne Ingrid Ward Individual Corporate Director Oct 27, 2011 100%
Operational/Managerial Control Oct 27, 2011 100%
Howard Robinson Individual Corporate OfficerChairman Board of Directors Jan 1, 2019 100%
Susan Turner Individual Corporate Director Sep 1, 2019

Practitioners & affiliated clinicians

Practitioners 63

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.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1447723564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17746 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604773936",
            "telephone_number": "708-444-1012",
            "fax_number": "708-614-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W 14TH ST",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112463",
            "telephone_number": "708-985-3040",
            "fax_number": "708-474-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND PRAIRIE SERVICES",
        "enumeration_date": "2019-01-11",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "SHARRONNE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "708-444-1012"
    },
    "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 Heights, IL

Sources for this page

Verify at the official NPI Registry.