NPIMap

Organization Active NPI

Heartland Community Health Clinic

Doing business as Heartland Health Services - Wisconsin

  • Federally Qualified Health Center (FQHC)
  • Peoria, IL
National Provider Identifier
1467658443
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEARTLAND COMMUNITY HEALTH CLINIC
Doing business as
Heartland Health Services - Wisconsin
Practice address
2321 N Wisconsin Ave
Peoria, IL 61603-5613
Phone
(309) 680-7600
Fax
(309) 681-4681
NPI assigned
Jun 26, 2007
Last updated
Aug 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Authorized official

Name
Katie Saucedo
Title
Revenue Cycle Manager
Phone
(309) 680-7600

Specialties & licenses 1

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

Addresses

Primary practice location

2321 N Wisconsin Ave
Peoria, IL 61603-5613

Mailing address

2214 N University St
Peoria, IL 61604-3221
Phone (309) 680-7600

Other names 1

  • Heartland Health Services - Wisconsin Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070927000034 IL Part A Provider - Federally Qualified Health Center (FQHC) 7416850318 Practice locations: Peoria, IL
O20170608000958 IL Part B Supplier - Clinic/Group Practice 7416850318 Receives reassigned benefits from 12 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Peoria, IL; Pekin, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467658443. Details of each certification follow.

Federally qualified health center certification: CCN 141044

Legal name
HEARTLAND COMMUNITY HEALTH CLINIC
Doing business as
HEARTLAND HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 28, 2007
Last certification
Sep 28, 2007
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1990 in IL
Enrollment address
2321 N Wisconsin Ave
Peoria, IL 61603-5613

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Heartland Community Health Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Sally G Cloyd Individual Corporate DirectorBoard Member Feb 1, 2014
Melody L Shake Individual Corporate OfficerVPQC Jul 30, 2018
W-2 Managing EmployeeVPQC Jul 30, 2018
Todd J Baker Individual Corporate Director Mar 22, 2019
Janet a Goldsworthy Individual Corporate DirectorBoard Member Feb 1, 2014
Craig D Williams Individual Corporate Director Jul 30, 2018
Andrew a Rand Individual Corporate DirectorBoard Member Feb 1, 2014
Sarah P Snyder Individual Corporate Director Jul 30, 2018
Alneida Ford Individual Corporate Director Jul 30, 2018
David C Stenerson Individual Corporate Director Jul 30, 2018
Staci D Ogborn Individual Corporate OfficerCS Jul 30, 2018
W-2 Managing EmployeeCS Jul 30, 2018
Laurie K Covington Individual Corporate Director Jul 30, 2018
Linda a Fox Individual Corporate Director Jul 30, 2018
Gregg D Stoner Individual Corporate OfficerCmo Feb 1, 2014
W-2 Managing EmployeeCmo Feb 1, 2014
Stephen E Bash Individual Corporate Director Jul 30, 2018
Antonio S Banegas Individual Corporate Director Jul 30, 2018
Michael J Cohlman Individual Corporate OfficerCfo Mar 22, 2019
W-2 Managing EmployeeCfo Mar 22, 2019
Sharon a Adams Individual Corporate OfficerCeo Mar 22, 2019
W-2 Managing EmployeeCeo Mar 22, 2019
Maria G Herrera Individual Corporate DirectorBoard Member Feb 1, 2014
Robert G Grove Individual Corporate Director Jul 30, 2018
Wayne W Cannon Individual Corporate DirectorBoard Member Feb 1, 2014
Gale S Thetford Individual Corporate Director Jul 30, 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 8

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": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1467658443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7600",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 N WISCONSIN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616035613",
            "telephone_number": "309-680-7600",
            "fax_number": "309-681-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND COMMUNITY HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A",
        "authorized_official_last_name": "SAUCEDO",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "309-680-7600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Services - Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.