NPIMap

Organization Active NPI

PCC Community Wellness Center

Doing business as PCC Austin Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1609892223
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
002 Issued in IL
Legal business name
PCC COMMUNITY WELLNESS CENTER
Doing business as
PCC Austin Family Health Center
Practice address
5461 W Lake St
Chicago, IL 60644-2342
Phone
(773) 378-3347
Fax
(773) 378-4028
NPI assigned
Jul 15, 2006
Last updated
Jan 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PCC COMMUNITY WELLNESS CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • PCC Austin Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609892223. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 14, 1992 in IL
Enrollment address
5461 W Lake St
Chicago, IL 60644

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
14D2311668PCC Austin Family Health Center5461 W Lake St, Chicago, IL 60644Provider-performed microscopySep 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
PCC Community Wellness Ctr21 organizations share this tax ID, including this one
Part of
PCC Community Wellness Ctr

Other organizations with this tax ID 20

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

View all 20

Locations

335 N Mason Ave
Chicago, IL 60644
Phone (773) 378-3347

5233 W Diversey Ave
Chicago, IL 60639

645 S Central Ave
Fl 6
Chicago, IL 60644
Phone (708) 854-5579

645 S Central Ave
Ste 600
Chicago, IL 60644

1 Erie Ct
Ste 7140
Oak Park, IL 60302
Phone (708) 763-1400

3 Erie Ct
Ste L1300
Oak Park, IL 60302

Ownership & related parties

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

Owners & managing parties with NPI records 2

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

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

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 64

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 64

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1609892223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022606",
            "telephone_number": "708-406-3927",
            "fax_number": "708-406-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5461 W LAKE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606442342",
            "telephone_number": "773-378-3347",
            "fax_number": "773-378-4028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5425 W Lake St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606442342",
            "country_code": "US",
            "telephone_number": "708-406-3927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PCC COMMUNITY WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PCC COMMUNITY WELLNESS CENTER",
        "enumeration_date": "2006-07-15",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "SIANGHIO",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "708-524-7686"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": "002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCC Austin Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PCC Austin Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.