NPIMap

Organization Active NPI

Promise Healthcare NFP

Doing business as Promise Healthcare - Kenyon

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
National Provider Identifier
1588453724
Registry record updated May 5, 2025
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
Promise Healthcare - Kenyon
Practice address
201 W Kenyon Rd Ste 4E
Champaign, IL 61820-7835
Phone
(217) 356-1558
NPI assigned
May 5, 2025
Last updated
May 5, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROMISE HEALTHCARE NFPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2025

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 1

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

Addresses

Primary practice location

201 W Kenyon Rd Ste 4E
Champaign, IL 61820-7835

Mailing address

819 Bloomington Rd
Champaign, IL 61820-2101
Phone (217) 403-5403

Other names 1

  • Promise Healthcare - Kenyon Doing business as

Medicare participation

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

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Urbana, IL; Rantoul, IL; Champaign, IL
O20251224001654 IL Part A Provider - Federally Qualified Health Center (FQHC) 6103071345 Practice locations: Champaign, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588453724. Details of each certification follow.

Federally qualified health center certification: CCN C41056

Legal name
PROMISE HEALTHCARE NFP
Doing business as
PROMISE HEALTHCARE - KENYON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 18, 2025
Last certification
Nov 18, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
201 W Kenyon Rd
Ste 4E
Champaign, IL 61820-7835

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
Tax ID family
Promise Healthcare NFP10 organizations share this tax ID, including this one
Part of
Promise Healthcare NFP

Other organizations with this tax ID 9

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

Locations

201 W Kenyon Rd
Ste 4E
Champaign, IL 61820
Phone (217) 356-1558

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Minnie Pearson Individual Corporate DirectorBoard Member Aug 14, 2012
Keith Flores Individual Corporate OfficerCfo Jan 15, 2024
W-2 Managing EmployeeCfo Jan 15, 2024
Claudia Lennoff Individual Corporate Director Aug 14, 2012
April Arrasmith Individual W-2 Managing Employee Nov 1, 2012

Practitioners & affiliated clinicians

Practitioners 1

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": "1746403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1588453724",
    "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": "217-403-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W KENYON RD STE 4E",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207835",
            "telephone_number": "217-356-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMISE HEALTHCARE NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROMISE HEALTHCARE NFP",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Promise Healthcare - Kenyon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.