NPIMap

Organization Active NPI

Friend Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1457330870
Registry record updated Oct 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FRIEND FAMILY HEALTH CENTER, INC
Practice address
5843 S. Western Avenue
Chicago, IL 60636
Phone
(773) 702-2193
Fax
(773) 702-4356
NPI assigned
Jan 13, 2006
Last updated
Oct 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2009

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

Authorized official

Name
Sabrina Modre
Title
Cfo
Phone
(773) 702-2193

Specialties & licenses 1

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

Addresses

Primary practice location

5843 S. Western Avenue
Chicago, IL 60636

Mailing address

5843 S. Western Avenue
Chicago, IL 60636
Phone (773) 702-2193

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040625000215 IL Part A Provider - Federally Qualified Health Center (FQHC) 2062494552 Practice locations: Chicago, IL
O20040805001242 IL Part B Supplier - Clinic/Group Practice 2062494552 Receives reassigned benefits from 129 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457330870. Details of each certification follow.

Federally qualified health center certification: CCN 141984

Legal name
FRIEND FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 26, 2004
Last certification
Jul 26, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 28, 2000 in IL
Enrollment address
5843 S Western Ave
Chicago, IL 60636-1526

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 8

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
14D1077524Friend Family Health Center5843 S Western, Chicago, IL 60636Provider-performed microscopyDec 11, 2027

National Provider Directory

National Provider Directory

Locations

340 E 51st St
Chicago, IL 60615
Phone (773) 966-0333

5843 S Western Ave
Chicago, IL 60636
Phone (773) 434-8600

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
Judy Juarez Individual Corporate DirectorBoard Member Sep 1, 2021
Wendy Thompson Individual Corporate DirectorCeo Jun 30, 2024
W-2 Managing Employee Jun 30, 2024
Operational/Managerial ControlCeo Jun 30, 2024
Joanne Glenn Individual Corporate DirectorExecutive Board Member Oct 1, 2014
Maria McManus Individual Corporate DirectorSecretary Aug 23, 2024
Raheel Shahzad Individual Corporate OfficerCfo Aug 23, 2024
W-2 Managing EmployeeCfo Aug 23, 2024
Operational/Managerial ControlCfo Aug 23, 2024

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1457330870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5843 S. WESTERN AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60636",
            "telephone_number": "773-702-2193",
            "fax_number": "773-702-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5843 S. WESTERN AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60636",
            "telephone_number": "773-702-2193",
            "fax_number": "773-702-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIEND FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "MODRE",
        "authorized_official_first_name": "SABRINA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "773-702-2193"
    },
    "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.