NPIMap

Organization Active NPI

Chicago Family Health Center, Inc.

Doing business as Chicago Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1629388756
Registry record updated Sep 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHICAGO FAMILY HEALTH CENTER, INC.
Doing business as
Chicago Family Health Center
Practice address
3223 W. 63Rd St.
Chicago, IL 60629
Phone
(773) 768-5000
Fax
(773) 778-9593
NPI assigned
Oct 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2016

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

Authorized official

Name
Mr. Joseph Eric Boklage
Title
Chief Administrative Officer
Phone
(773) 768-5000

Specialties & licenses 1

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

Addresses

Primary practice location

3223 W. 63Rd St.
Chicago, IL 60629

Mailing address

9119 S Exchange Ave
Chicago, IL 60617-4225
Phone (773) 768-5000

Other names 1

  • Chicago Family Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311000364 IL Part B Supplier - Clinic/Group Practice 6608765417 Receives reassigned benefits from 40 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20110317000186 IL Part A Provider - Federally Qualified Health Center (FQHC) 6608765417 Practice locations: Chicago, IL

Federally qualified health center certification: CCN 141143

Legal name
CHICAGO FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2011
Last certification
Mar 17, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 6, 1976 in IL
Enrollment address
3223 W 63Rd St
Chicago, IL 60629-3333

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Chicago Family Health C18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

3223 W 63rd St
Chicago, IL 60629
Phone (773) 735-4884

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Lyleth Rodriguez Individual Corporate DirectorBoard Member Jan 11, 1982
James Simmons Individual Corporate DirectorBoard Member Sep 15, 1988
Roy Carlton Individual Corporate OfficerChief Financial Officer Sep 10, 2023
Amelia Rodriguez Individual W-2 Managing EmployeeSenior Accountant Jun 23, 1981
Lupe Valadez Individual Corporate DirectorBoard Member Feb 10, 1977
Nora Reyes Individual Corporate DirectorBoard Member May 24, 2007
Mark Brummel Individual Corporate DirectorBoard Member Feb 10, 1977
Fulton Nolen Individual Corporate DirectorBoard Member Dec 17, 2013

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1629388756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9119 S EXCHANGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174225",
            "telephone_number": "773-768-5000",
            "fax_number": "773-768-6153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 W. 63RD ST.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60629",
            "telephone_number": "773-768-5000",
            "fax_number": "773-778-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-07",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "BOKLAGE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "773-768-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "Chicago Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.