NPIMap

Organization Active NPI

Access Community Health Network

Doing business as Kedzie Family Healthcenter

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1598844268
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ACCESS COMMUNITY HEALTH NETWORK
Doing business as
Kedzie Family Healthcenter
Practice address
3229-43 W 47TH PL
Chicago, IL 60632-3011
Phone
(773) 254-6044
Fax
(773) 254-6115
NPI assigned
Nov 3, 2006
Last updated
May 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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

Authorized official

Name
Donna Thompson
Title
Ceo
Phone
(312) 526-2051

Specialties & licenses 1

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

Addresses

Primary practice location

3229-43 W 47TH PL
Chicago, IL 60632-3011

Mailing address

600 W Fulton
Suite 200
Chicago, IL 60661-1262
Phone (312) 526-2051

Other names 1

  • Kedzie Family Healthcenter Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030326000044 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537076112 Practice locations: Chicago, IL
O20031204000985 IL Part B Supplier - Clinic/Group Practice 9537076112 Receives reassigned benefits from 512 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Chicago Heights, IL; Cicero, IL; Des Plaines, IL; Evanston, IL; Heights, IL; Melrose Park, IL; Summit, IL…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598844268. Details of each certification follow.

Federally qualified health center certification: CCN 141952

Legal name
ACCESS COMMUNITY HEALTH NETWORK
Doing business as
KEDZIE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 28, 2003
Last certification
Jul 28, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 11, 1984 in IL
Enrollment address
3229W 47TH PL 43
Chicago, IL 60632-3011

National Provider Directory

National Provider Directory
Tax ID family
Family Health Corner29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Perla Herrera Individual Corporate Director Sep 1, 2013
Donna Thompson Individual Corporate OfficerCeo Jul 1, 1995 100%
W-2 Managing EmployeeCeo Jul 1, 1995 100%
Thomas P Fitzgibbon Individual Corporate Director Mar 1, 2013
Virginia Oviedo Individual Corporate Director Apr 1, 2011
Julio Morejon Individual Corporate Director Jul 1, 2019
Denise Kitchen Individual Corporate Director Jun 1, 2007
Patricia Bobb Individual Corporate Director Jul 10, 2010
Donna Simmons Individual Corporate Director Mar 1, 2000
Peter McNerney Individual Corporate Director Feb 1, 2015
Terry Brown Individual Corporate Director Mar 1, 2000
Elizabeth Perez Individual Corporate Director Sep 1, 2017
Matthew Berkley Individual Corporate Director Jun 1, 2018
Lilia Gonzalez Individual Corporate Director Jan 1, 2018
Miriam Mobley-Smith Individual Corporate Director Sep 1, 2017
Erin Starkey Individual Corporate Director Jul 1, 2010
Ryan Hart Individual Corporate Director Mar 1, 2013
Sharon Gibson Individual Corporate Director Jan 1, 2018
Charles Deshazer Individual Corporate Director Apr 1, 2011

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431043200000",
    "number": "1598844268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W FULTON",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606611262",
            "telephone_number": "312-526-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3229-43 W 47TH PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323011",
            "telephone_number": "773-254-6044",
            "fax_number": "773-254-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2015-05-08",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-526-2051"
    },
    "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": "Kedzie Family Healthcenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.