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PCC Community Wellness Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago, IL

NPI 1609892223 · NPPES record last updated Jan 10, 2025

Key facts

NPI
1609892223
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
002 (IL)
Legal business name
PCC COMMUNITY WELLNESS CENTER
Practice address
5461 W Lake St
Chicago, IL 60644-2342
Phone
(773) 378-3347
Fax
(773) 378-4028
NPI assigned
Jul 15, 2006
Organization subpart
Yes
Parent organization (as reported)
PCC COMMUNITY WELLNESS CENTER

Authorized official

Name
Alyssa Sianghio
Title
President Ceo
Phone
(708) 524-7686

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 16

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

Corporate family (same tax ID) 20

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

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 106

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2311668PCC Austin Family Health Center
5461 W Lake St, Chicago, IL 60644		Provider-performed microscopySep 25, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Federally qualified health center certification: CCN 141889

Legal name
PCC COMMUNITY WELLNESS CENTER
Doing business as
PCC AUSTIN FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 1998
Last certification
Apr 16, 1998
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Apr 14, 1992 in IL
Enrollment address
5461 W Lake St
Chicago, IL 60644

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Sonia Taylor
Individual 		Corporate Director
Senior Director of Finance		 Jan 28, 2024
W-2 Managing Employee Dec 11, 2023
Alyssa Sianghio
Individual 		Corporate Officer
President and Ceo		 Apr 10, 2024 100%
W-2 Managing Employee
Ad;		 Apr 10, 2024 100%
John McDonnell
Individual 		Corporate Director
Board Member		 Jul 26, 2011
Patricia Ford
Individual 		Corporate Director
Board Member		 Aug 25, 2009
Richard Ducatenzeller
Individual 		Corporate Director
Board Member		 Jul 1, 2024
Christopher Barracks
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Ron Austin
Individual 		Corporate Director
Board Member		 Oct 1, 2008
Nilsa Campos
Individual 		Corporate Officer
Chief Operating Officer		 Sep 1, 2021 100%
W-2 Managing Employee
Chief Operating Officer		 Sep 1, 2021 100%
Velda Brunner
Individual 		Corporate Director
Board Member		 Nov 29, 2015
Hiren Patel
Individual 		Corporate Director
Chief Financial Officer		 Sep 11, 2024 100%
W-2 Managing Employee Sep 11, 2024
Jerrard D Walker
Individual 		Corporate Officer
Chief Population Health Officer		 Mar 8, 2021 100%
W-2 Managing Employee
Chief Population Health Officer		 Mar 8, 2021 100%
Janet Y Forbes
Individual 		Corporate Director
Board Member		 Jul 1, 2023
Wrenetha Julion
Individual 		Corporate Director
Board Member		 Jul 1, 2020
Sara Hogue
Individual 		Corporate Officer
Chief Quality Improvement Officer		 Jan 1, 2020 100%
W-2 Managing Employee Jan 1, 2020
Melissa Kirk
Individual 		Corporate Director
Board Member		 Jul 1, 2024
Paul Luning
Individual 		Corporate Officer
Chief Medical Officer		 Sep 17, 2007 100%
W-2 Managing Employee
Chief Medical Officer		 Sep 17, 2007 100%
Kenneth M Blair
Individual 		Corporate Director
Board Treasurer		 Oct 1, 2008

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
PCC Dr Tong Health Center
Oak Park, IL · CCN 141034		 Federally qualified health center Other (100%) Sep 15, 2004
PCC Walk-in Wellness Center at West Suburban Medical Center
Oak Park, IL · CCN 781802		 Federally qualified health center Other (100%) Sep 15, 2004

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081121000628 IL Part a Provider - Federally Qualified Health Center (FQHC) 1557270139 Practice locations: Chicago, IL

National Provider Directory

Tax ID family
PCC Community Wellness Ctr (21 organizations share this tax ID)
Part of
PCC Community Wellness Ctr

Locations

1044 N Mozart St
Ste 200
Chicago, IL 60622

3030 N Mobile Ave
Chicago, IL 60634
Phone (773) 534-3030

645 S Central Ave
Ste 600
Chicago, IL 60644

5233 W Diversey Ave
Chicago, IL 60639

1044 N Mozart St
Ste 203
Chicago, IL 60622
Phone (773) 292-8227

645 S Central Ave
Fl 6
Chicago, IL 60644
Phone (773) 626-4300

3 Erie Ct
Ste L1300
Oak Park, IL 60302

3 Erie Ct
Oak Park, IL 60302
Phone (708) 763-6200

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 002 IL Yes

Addresses

Primary practice location

5461 W Lake St
Chicago, IL 60644-2342

Mailing address

14 Lake St
Oak Park, IL 60302-2606
Phone (708) 406-3927

Other practice location 1

5425 W Lake St
Chicago, IL 60644-2342
Phone (708) 406-3927

Other identifiers

IdentifierTypeStateIssuer
=========MedicaidIL
141889OtherMEDICARE PART A PROVIDER NUMBER

Other names

  • PCC Austin Family Health Center Doing business as

Other providers in Chicago, IL

All providers in Chicago, IL · Federally Qualified Health Center (FQHC) in Illinois

Sources for this page

Verify at the official NPI Registry.