NPIMap

Organization Active NPI

Tapestry 360 Health

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1609289883
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TAPESTRY 360 HEALTH
Practice address
1300 W Devon Ave
Chicago, IL 60660-1302
Phone
(773) 296-7544
Fax
(773) 296-7637
NPI assigned
Jun 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Authorized official

Name
Nicole Willis
Title
Ceo
Phone
(773) 751-7800

Specialties & licenses 1

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

Addresses

Primary practice location

1300 W Devon Ave
Chicago, IL 60660-1302

Mailing address

1301 W Devon Ave
Chicago, IL 60660-1329
Phone (773) 751-7800

Other names 2

  • Heartland Health Centers Doing business as
  • Tapestry 360 Health - Devon Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140821000339 IL Part A Provider - Federally Qualified Health Center (FQHC) 2466353305 Practice locations: Chicago, IL

Federally qualified health center certification: CCN 781825

Legal name
TAPESTRY 360 HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 25, 2014
Last certification
Sep 25, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1992 in IL
Enrollment address
1300 W Devon Ave
Chicago, IL 60660-1302

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1073243Tapestry 360 Health1300 W Devon Ave, Chicago, IL 60660Certificate of waiverSep 10, 2026

National Provider Directory

National Provider Directory
Tax ID family
Heartland Health Centers24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

1300 W Devon Ave
Chicago, IL 60660
Phone (773) 751-7850

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jerome Lucas Individual Corporate DirectorBoard Director Dec 31, 2017
Diane Macdonald Individual Corporate DirectorBoard Treasurer Dec 31, 2016
Olusegun Ogunleye Individual Corporate DirectorBoard Director Dec 31, 2022
Nicolas Peneff Individual Corporate DirectorBoard Director Dec 31, 2021
Coletta Sargant Individual Corporate DirectorBoard Vice-Chair Dec 31, 2022
Kristen Plocinik Individual Corporate DirectorBoard Chair Dec 31, 2017
Pemba Bayo Individual Corporate DirectorBoard Secretary Dec 31, 2018
Tasneem Qureshi Individual Corporate DirectorBoard Director Dec 31, 2016
Nicole Willis Individual Corporate OfficerCeo Jan 18, 2018
Barbara Wahler Individual Corporate DirectorBoard Director Dec 31, 2022
Shaleka Smith Individual W-2 Managing EmployeeSenior Manager, Provider & Board Re Jan 24, 2011
Matthew Katzfey Individual Corporate DirectorBoard Director Dec 31, 2018

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1609289883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601329",
            "telephone_number": "773-751-7800",
            "fax_number": "773-437-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601302",
            "telephone_number": "773-296-7544",
            "fax_number": "773-296-7637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAPESTRY 360 HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-751-7800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tapestry 360 Health - Devon",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.