Heartland Community Health Clinic
Organization Active NPI Federally Qualified Health Center (FQHC) · Peoria, IL
NPI 1497798607 · NPPES record last updated Aug 15, 2025
Key facts
- NPI
- 1497798607
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- HEARTLAND COMMUNITY HEALTH CLINIC
- Practice address
- 711 W John H Gwynn Jr Ave
Peoria, IL 61605-2270 - Phone
- (309) 680-7600
- NPI assigned
- Jun 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Katie Saucedo
- Title
- Revenue Cycle Manager
- Phone
- (309) 680-7600
Owners & managing parties with NPI records 1
-
Gregg D Stoner, MD
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 7
Practitioners 51
-
Brogan Edward Bahler, M.D.
-
Joel Borden, M.D.
-
Katie T. Crawley, D.O.
-
Joshua A Croland, M.D.
-
Ashley Renee Droege, PA-C
-
Melvin A. Fleming, M.D.
-
Jeffrey J Galvan, MD
-
Deepshikha Garg, MD
-
Jessica Hanks, M.D.
-
Kaleb L. Jacobs, D.O.
-
Matthew D Jager, D.O.
-
Todd J Karas, DPM
-
Casey M Kimler, APN
-
Sarah R Koscica, MD
-
Teresa Lynch, M.D.
-
Angela Marie Miller, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1054066 | Heartland Health Services - John H Gwynn Jr | Certificate of waiver | Jun 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Federally qualified health center certification: CCN 141033
- 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 18, 2006
- Last certification
- Sep 18, 2006
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 16, 1990 in IL
- Enrollment address
- 711 W John H Gwynn Jr Ave
Peoria, IL 61605-2270
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Sally G Cloyd |
Corporate Director | Jan 4, 2013 | |
| Melody L Shake |
Corporate Officer |
Jul 30, 2018 | |
| W-2 Managing Employee |
Jul 30, 2018 | ||
| Todd J Baker |
Corporate Director | Mar 22, 2019 | |
| Janet a Goldsworthy |
Corporate Director | Jan 4, 2013 | |
| Craig D Williams |
Corporate Director | Jul 30, 2018 | |
| Andrew a Rand |
Corporate Director | Jul 30, 2018 | |
| Sarah P Snyder |
Corporate Director | Apr 1, 2014 | |
| Alneida Ford |
Corporate Director | Jul 30, 2018 | |
| David C Stenerson |
Corporate Director | Jul 30, 2018 | |
| Staci D Ogborn |
Corporate Officer |
Jul 30, 2018 | |
| W-2 Managing Employee |
Jul 30, 2018 | ||
| Laurie K Covington |
Corporate Director | Jul 30, 2018 | |
| Linda a Fox |
Corporate Director | Jul 30, 2018 | |
| Gregg D Stoner |
Corporate Officer |
Jul 17, 2006 | |
| W-2 Managing Employee |
Jul 17, 2006 | ||
| Stephen E Bash |
Corporate Director | Jul 30, 2018 | |
| Antonio S Banegas |
Corporate Director | Jul 30, 2018 | |
| Michael J Cohlman |
Corporate Officer |
Mar 22, 2019 | |
| W-2 Managing Employee |
Mar 22, 2019 | ||
| Sharon a Adams |
Corporate Officer |
Mar 22, 2019 | |
| W-2 Managing Employee |
Mar 22, 2019 | ||
| Maria G Herrera |
Corporate Director | Jan 4, 2013 | |
| Robert G Grove |
Corporate Director | Aug 26, 2014 | |
| Wayne W Cannon |
Corporate Director | Jan 4, 2011 | |
| Gale S Thetford |
Corporate Director | Jul 30, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060918000009 | 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 |
National Provider Directory
- Tax ID family
- Heartland Community Health Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
711 W John H Gwynn Jr Ave
Peoria, IL 61605-2270
Mailing address
2214 N University St
Peoria, IL 61604-3221
Phone (309) 680-7600
Other names
- Heartland Health Services - John H Gwynn Jr
Other providers in Peoria, IL
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Community Health Clinic
- Heartland Home Health Care
- Heartland Home Health Care
All providers in Peoria, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.