NPIMap

Organization Active NPI

Promise Healthcare NFP

Doing business as Frances Nelson Health Center

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
National Provider Identifier
1578821005
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PROMISE HEALTHCARE NFP
Doing business as
Frances Nelson Health Center
Practice address
819 Bloomington Rd
Champaign, IL 61820
Phone
(217) 356-1558
NPI assigned
May 3, 2012
Last updated
Jun 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Authorized official

Name
Jennifer Henry
Title
Ceo
Phone
(217) 403-5401

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

819 Bloomington Rd
Champaign, IL 61820

Mailing address

819 Bloomington Rd
Champaign, IL 61820-2101
Phone (217) 356-1558

Other practice location 1

424 E Wabash
Rantoul, IL 61866-3013
Phone (217) 356-1558

Other practice location 2

919 W Kirby Ave
Champaign, IL 61821-5121
Phone (217) 356-1558

Other names 1

  • Frances Nelson Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20130219000476 IL Part B Supplier - Clinic/Group Practice 6103071345 Receives reassigned benefits from 54 practitioners
7 other NPIs on this enrollment
Practice locations: Urbana, IL; Rantoul, IL; Champaign, IL
O20130411000333 IL Part A Provider - Federally Qualified Health Center (FQHC) 6103071345 Practice locations: Champaign, IL
O20230922000281 IL Part A Provider - Federally Qualified Health Center (FQHC) 6103071345 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Champaign, IL
O20231213000823 IL Part A Provider - Federally Qualified Health Center (FQHC) 6103071345 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rantoul, IL

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1578821005. Details of each certification follow.

Federally qualified health center certification: CCN 141192

Legal name
PROMISE HEALTHCARE NFP
Doing business as
FRANCIS NELSON HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 18, 2013
Last certification
Apr 18, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 2003 in IL
Enrollment address
819 Bloomington Rd
Champaign, IL 61820-2101

Federally qualified health center certification: CCN C41006

Legal name
PROMISE HEALTHCARE NFP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2023
Last certification
Sep 8, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 2003 in IL
Enrollment address
919 W Kirby Ave
Champaign, IL 61821-5121

Federally qualified health center certification: CCN C41014

Legal name
PROMISE HEALTHCARE NFP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 12, 2023
Last certification
Dec 12, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 2003 in IL
Enrollment address
424 E Wabash Ave
Rantoul, IL 61866-3013

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

424 E Wabash Ave
Rantoul, IL 61866
Phone (217) 356-1558

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Brice Hutchcraft Individual Corporate DirectorBoard Member Sep 22, 2015
Corporate Director Sep 22, 2015
Corporate Director Sep 1, 2023
Kandace Turner Individual Corporate DirectorVice Chairman Sep 25, 2018
Corporate Director Sep 25, 2018
Corporate Director Sep 1, 2023
Minnie Pearson Individual Corporate OfficerVice President Aug 6, 2012
Corporate DirectorBoard Member Aug 6, 2012
Corporate Director Aug 6, 2012
Corporate Director Sep 1, 2023
Keith Flores Individual Corporate Officer Jan 15, 2024
W-2 Managing Employee Jan 15, 2024
Corporate OfficerCfo Jan 15, 2024
Scott Greenlee Individual Corporate DirectorBoard Member Sep 25, 2018
Corporate Director Sep 25, 2018
Corporate Director Sep 1, 2023
Claudia Lennoff Individual Corporate DirectorBoard Member Aug 6, 2012
Corporate Director Aug 6, 2012
Corporate Director Sep 1, 2023
Robert Lewis Individual Corporate DirectorBoard Member Sep 22, 2020
Corporate Director Sep 22, 2020
Corporate Director Sep 1, 2023
Paulette Colemon-Peeples Individual Corporate DirectorBoard Member Sep 22, 2020
Corporate Director Sep 22, 2020
Corporate Director Sep 1, 2023
Pamela Bigler Individual Corporate DirectorBoard Member May 22, 2018
Corporate Director May 22, 2018
Corporate Director Sep 1, 2023
Joseph Guyette Individual Corporate DirectorBoard Member Sep 27, 2016
Corporate Director Sep 27, 2016
Corporate Director Sep 1, 2023
April Arrasmith Individual W-2 Managing EmployeeBilling Manager Feb 1, 2021
W-2 Managing Employee Nov 1, 2012
W-2 Managing Employee Sep 1, 2023
Jennifer Henry Individual Corporate DirectorExecutive Director Jun 30, 2021
Corporate Director Jun 30, 2021
Corporate Officer Sep 1, 2023
W-2 Managing Employee Sep 1, 2023
Operational/Managerial Control Sep 1, 2023
Stacey McKeever Individual Corporate Director Sep 22, 2020
Corporate Director Sep 1, 2023

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1578821005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 BLOOMINGTON RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202101",
            "telephone_number": "217-356-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 BLOOMINGTON RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-356-1558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 E Wabash",
            "address_purpose": "LOCATION",
            "city": "Rantoul",
            "state": "IL",
            "postal_code": "618663013",
            "country_code": "US",
            "telephone_number": "217-356-1558",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "919 W Kirby Ave",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618215121",
            "country_code": "US",
            "telephone_number": "217-356-1558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROMISE HEALTHCARE NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-03",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-403-5401"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frances Nelson Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Frances Nelson Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.