NPIMap

Organization Active NPI

Promise Healthcare NFP

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
National Provider Identifier
1629828439
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PROMISE HEALTHCARE NFP
Practice address
919 W Kirby Ave
Champaign, IL 61821-5121
Phone
(217) 356-5477
NPI assigned
Mar 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Authorized official

Name
Jennifer Henry
Title
Ceo
Phone
(217) 403-5401

Specialties & licenses 1

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

Addresses

Primary practice location

919 W Kirby Ave
Champaign, IL 61821-5121

Mailing address

919 W Kirby Ave
Champaign, IL 61821-5121

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130219000476 IL Part B Supplier - Clinic/Group Practice 6103071345 Receives reassigned benefits from 54 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Urbana, IL; Rantoul, IL; Champaign, IL
O20230922000281 IL Part A Provider - Federally Qualified Health Center (FQHC) 6103071345 1 other NPI on this enrollment
Practice locations: Champaign, IL

Federally qualified health center certification: CCN C41006

Legal name
PROMISE HEALTHCARE NFP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2023
Last certification
Sep 8, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 2003 in IL
Enrollment address
919 W Kirby Ave
Champaign, IL 61821-5121

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Promise Healthcare NFP10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

819 Bloomington Rd
Champaign, IL 61820
Phone (217) 356-1558

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
Brice Hutchcraft Individual Corporate Director Sep 22, 2015
Kandace Turner Individual Corporate Director Sep 25, 2018
Minnie Pearson Individual Corporate Director Aug 6, 2012
Keith Flores Individual Corporate OfficerCfo Jan 15, 2024
Scott Greenlee Individual Corporate Director Sep 25, 2018
Claudia Lennoff Individual Corporate Director Aug 6, 2012
Robert Lewis Individual Corporate Director Sep 22, 2020
Paulette Colemon-Peeples Individual Corporate Director Sep 22, 2020
Pamela Bigler Individual Corporate Director May 22, 2018
Joseph Guyette Individual Corporate Director Sep 27, 2016
Stacey McKeever Individual Corporate Director Sep 22, 2020
April Arrasmith Individual W-2 Managing Employee Nov 1, 2012
Jennifer Henry Individual Corporate Director Jun 30, 2021

Practitioners & affiliated clinicians

Practitioners 3

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": "1711324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1629828439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 W KIRBY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 W KIRBY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215121",
            "telephone_number": "217-356-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMISE HEALTHCARE NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-403-5401"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.