Knox Community Health Center NFP

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

KNOX COMMUNITY HEALTH CENTER NFP

Practice address

1361 W Fremont St
Galesburg, IL 61401-2436

Phone

(309) 344-2225

Fax

(309) 344-2230

NPI assigned

Jul 26, 2012

Last updated

Mar 16, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michele Gabriel, MPH

Title

Ceo

Phone

(309) 344-2224

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649526773. Details of each certification follow.

• CCN 141171 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 141171

Legal name

KNOX COMMUNITY HEALTH CENTER NFP

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 31, 2012

Last certification

Oct 31, 2012

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 9, 2010 in IL

Enrollment address

1361 W Fremont St
Galesburg, IL 61401-2436

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• County of Knox

  dba Knox County Health Department

  • Public Health or Welfare Agency
  • Galesburg, IL
  • NPI 1205944394

  Member Of

  NPD member

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HJHHBD

All disclosed owners & managing parties 16

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

Owners & managing parties with NPI records 2

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

• County of Knox

  dba Knox County Health Department

  • Public Health or Welfare Agency
  • Galesburg, IL
  • NPI 1205944394

  5% Or Greater Direct Ownership Interest, Other

  CMS ownership
• County of Knox

  dba Knox County Nursing Home

  • Skilled Nursing Facility
  • Knoxville, IL
  • NPI 1326035304

  5% Or Greater Direct Ownership Interest, Other

  CMS ownership

Practitioners 9

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.

• Robert Wagner, M.D.

  • Family Medicine Physician
  • Galesburg, IL
  • NPI 1588663017
  Medicare reassignment Care Compare group NPD
• Lea Foy Os Capili

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1841984176
  Medicare reassignment Care Compare group
• William G. Barnes, MSW, LCSW

  • Clinical Social Worker
  • Macomb, IL
  • NPI 1013239896
  Medicare reassignment NPD
• Benjamin Clark, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Washington, IL
  • NPI 1467298257
  Medicare reassignment NPD
• Jazmin Nicole Johnson, DMD

  • Dentist
  • Galesburg, IL
  • NPI 1487542353
  Medicare reassignment NPD
• Chunrong Zhao

  • Marriage & Family Therapist
  • Galesburg, IL
  • NPI 1104367838
  Medicare reassignment NPD
• Hannah Erickson, ARNP

  • Family Nurse Practitioner
  • Galesburg, IL
  • NPI 1326765298
  NPD
• Crystal Johnson, LCSW

  • Clinical Social Worker
  • Galesburg, IL
  • NPI 1366921884
  NPD
• Carol Candler

  • Family Nurse Practitioner
  • Gillespie, IL
  • NPI 1770942716
  NPD (past)

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1649526773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 W FREMONT ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614012436",
            "telephone_number": "309-344-2225",
            "fax_number": "309-344-2230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 W FREMONT ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614012436",
            "telephone_number": "309-344-2225",
            "fax_number": "309-344-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOX COMMUNITY HEALTH CENTER NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "GABRIEL",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-344-2224",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela B Klapp, APN
• Knox Clinic Corp
• Knox Clinic Corp (Medical Arts Clinic)
• Knox Clinic Corp (Pediatric and Adolescent Care)
• Knox Clinic Corp (Cottage Orthopedics and Podiatry)
• Knox County Hearing
• Knox Family Dental LLC
• Knox Family Orthodontics LLC
• Knox OB-GYN, LTD
• Knox Warren Spec Educ District

• Federally Qualified Health Center (FQHC) in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.