NPIMap

Organization Active NPI

Tapestry 360 Health

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1629217161
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
2645 W Lawrence
Chicago, IL 60625-2944
Phone
(773) 437-8004
Fax
(773) 275-1681
NPI assigned
Feb 6, 2009
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 IL Primary

Addresses

Primary practice location

2645 W Lawrence
Chicago, IL 60625-2944

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 - Lincoln Square Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100218000683 IL Part A Provider - Federally Qualified Health Center (FQHC) 2466353305 Practice locations: Chicago, IL

Federally qualified health center certification: CCN 141116

Legal name
TAPESTRY 360 HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 18, 2010
Last certification
Feb 18, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1992 in IL
Enrollment address
2645 W Lawrence Ave
Chicago, IL 60625-2944

Other NPIs with the same Medicare PAC ID 10

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

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

3048 N Wilton Ave
Fl 2
Chicago, IL 60657
Phone (773) 296-5424

2645 W Lawrence Ave
Chicago, IL 60625
Phone (773) 275-1680

Ownership & related parties

All disclosed owners & managing parties 13

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
Laurie a Carrier Individual Corporate OfficerCmo Nov 7, 2018
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 2

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": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1629217161",
    "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": "2645 W LAWRENCE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252944",
            "telephone_number": "773-437-8004",
            "fax_number": "773-275-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAPESTRY 360 HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "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": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tapestry 360 Health - Lincoln Square",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.