NPIMap

Organization Active NPI

Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Champaign, IL
National Provider Identifier
1639791569
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Practice address
201 W Kenyon Rd BLDG D
Champaign, IL 61820-7892
Phone
(312) 795-0000
NPI assigned
May 14, 2020
Last updated
May 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Authorized official

Name
Eleace Sawyers
Title
Ceo
Phone
(312) 795-0000

Specialties & licenses 1

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

Addresses

Primary practice location

201 W Kenyon Rd BLDG D
Champaign, IL 61820-7892

Mailing address

205 W Randolph St Ste 2222
Chicago, IL 60606-1814
Phone (312) 795-0000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130723000458 IL Part B Supplier - Clinic/Group Practice 6901053511 Receives reassigned benefits from 39 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rantoul, IL; Princeville, IL; Mendota, IL; Harvard, IL; Champaign, IL; Aurora, IL; Kankakee, IL
O20200519002175 IL Part A Provider - Federally Qualified Health Center (FQHC) 6901053511 Practice locations: Champaign, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639791569. Details of each certification follow.

Federally qualified health center certification: CCN 781938

Legal name
COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2020
Last certification
May 19, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 1991 in IL
Enrollment address
201 W Kenyon Rd
BLDG D
Champaign, IL 61820-7892

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 9

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Partnership of Illinois12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

201 W Kenyon Rd
Bldg D
Champaign, IL 61820
Phone (312) 795-0000

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Susana Castro Individual Corporate OfficerChair Jun 1, 1996
Cristina Davalos Individual Corporate OfficerBoard Member May 1, 2005
Gelacia Leija Individual Corporate OfficerSecretary Jun 1, 1996
Amelia Garza -Vela Individual Corporate OfficerBoard Member Jun 1, 2022
Lorenia Lara Individual Corporate OfficerVice Chair Jul 1, 2023
Natalie Ojeda Individual Corporate OfficerBoard Member Dec 1, 2023
Linda Ramirez Individual Corporate OfficerBoard Member Mar 1, 2024
Eleace Sawyers Individual Corporate OfficerCeo Mar 9, 2020
W-2 Managing EmployeeAd; Mar 9, 2020
Maria Roach Individual Corporate OfficerBoard Member Dec 1, 2023
Kevin Wood Individual Corporate OfficerBoard Member Feb 1, 2021

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1639791569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W RANDOLPH ST STE 2222",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061814",
            "telephone_number": "312-795-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W KENYON RD BLDG D",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207892",
            "telephone_number": "312-795-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-14",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "SAWYERS",
        "authorized_official_first_name": "ELEACE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-795-0000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.