NPIMap

Organization Active NPI

Erie Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1548062318
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ERIE FAMILY HEALTH CENTER INC
Practice address
4305 W Madison St
Chicago, IL 60624
Phone
(312) 666-3494
NPI assigned
Mar 25, 2025
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Authorized official

Name
Judith C Eastridge
Title
Director of Credentialing
Phone
(312) 432-7329

Specialties & licenses 1

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

Addresses

Primary practice location

4305 W Madison St
Chicago, IL 60624

Mailing address

1701 W Superior St FL 3
Chicago, IL 60622-5646
Phone (312) 432-7329

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000689 IL Part B Supplier - Clinic/Group Practice 9537050422 Receives reassigned benefits from 396 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Evanston, IL; Lake Forest, IL; Waukegan, IL
O20251030004351 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537050422 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548062318. Details of each certification follow.

Federally qualified health center certification: CCN C41055

Legal name
ERIE FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 21, 2025
Last certification
Oct 21, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4305 W Madison St
Chicago, IL 60624

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Erie Family Health Cent18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

1313 N Claremont Ave
Chicago, IL 60622
Phone (773) 534-4044

1326 S Avers Ave
Chicago, IL 60623
Phone (773) 565-6903

1656 W Chicago Ave
Chicago, IL 60622
Phone (312) 666-3488

3155 W Lawrence Ave
Chicago, IL 60625
Phone (773) 588-9640

4015 N Ashland Ave
Chicago, IL 60613
Phone (773) 404-0447

4027 W Grenshaw St
Ste 113
Chicago, IL 60624
Phone (773) 534-8871

4305 W Madison St
Chicago, IL 60624

4757 N Kedzie Ave
Chicago, IL 60625

646 N Lawndale Ave
Chicago, IL 60624
Phone (312) 432-7423

2100 Ridge Ave
Evanston, IL 60201
Phone (847) 866-2948

109 N Seymour Ave
#M
Mundelein, IL 60060

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Celeste Castillo Individual Corporate DirectorSecretary Dec 1, 2007
Brian Marsella Individual Corporate DirectorBoard Chair Aug 1, 2007
Lee Francis Individual Corporate OfficerCeo Jul 1, 2008
Stephanie Smith Individual Corporate OfficerCfo Oct 13, 2025
Operational/Managerial ControlCfo Oct 13, 2025
Caroline M Hoke Individual Corporate OfficerChief Clinical Officer Mar 6, 2018
William Kistner Individual Corporate DirectorTreasurer Jul 1, 2002
Mychel Owens Individual W-2 Managing EmployeeManager, Managed Care Oct 22, 2022
Amy Valukas Individual Corporate OfficerChief Population Health Officer Jul 3, 2016
Carolyn a Dickens Individual Corporate DirectorVice Chair Nov 1, 2017
Eric Mayeda Individual Corporate DirectorDirector Sep 15, 2004

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 365

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 365

NPI Registry JSON

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

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1548062318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST FL 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-432-7329",
            "fax_number": "978-967-8345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 W MADISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60624",
            "telephone_number": "312-666-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "EASTRIDGE",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "312-432-7329"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.