NPIMap

Organization Active NPI

Esperanza Health Centers

Doing business as Esperanza Health Center at Marquette

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1669812582
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESPERANZA HEALTH CENTERS
Doing business as
Esperanza Health Center at Marquette
Practice address
6550 S Richmond St
Chicago, IL 60629-2821
Phone
(773) 584-6202
NPI assigned
Jun 25, 2013
Last updated
Sep 29, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
ESPERANZA HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Authorized official

Name
Jeffrey McInnes
Title
Director of Billing & Patient Acces
Phone
(773) 640-5785

Specialties & licenses 1

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

Addresses

Primary practice location

6550 S Richmond St
Chicago, IL 60629-2821

Mailing address

6550 S Richmond St
Chicago, IL 60629-2821
Phone (773) 584-6202

Other names 1

  • Esperanza Health Center at Marquette Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050204000750 IL Part B Supplier - Clinic/Group Practice 2961453105 Receives reassigned benefits from 125 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20140821001294 IL Part A Provider - Federally Qualified Health Center (FQHC) 2961453105 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669812582. Details of each certification follow.

Federally qualified health center certification: CCN 781822

Legal name
ESPERANZA HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 25, 2014
Last certification
Aug 25, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 26, 2004 in IL
Enrollment address
6550 S Richmond St
Chicago, IL 60629-2821

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 12

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2062024Esperanza Health Centers6550 S Richmond St, Chicago, IL 60629Certificate of waiverSep 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Centro de Salud Esperanza9 organizations share this tax ID, including this one
Part of
Centro de Salud Esperanza

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Jodi Portnoy Individual Corporate Director Jun 1, 2015
Elba Aranda-Suh Individual Corporate Director Sep 1, 2017
Destiny Ortega Individual Corporate Director Nov 1, 2021
Erica Martinez Individual Corporate Director Nov 1, 2021
Joel Rodarte Individual Corporate Director Oct 1, 2018
Alison Gia Mac Nicholoff Individual Corporate Director Sep 11, 2006
Andrew J Van Wieren Individual Corporate OfficerCmo Dec 1, 2017
Li Yu Tan Individual Corporate Director Apr 1, 2019
Michael Chico Individual Corporate DirectorChairperson Feb 1, 2018
Charles Wintersteen Individual Corporate Director Nov 1, 2016
Jaime Arteaga Individual Corporate Director Nov 1, 2019
Nyla Diab Individual Corporate DirectorSecretary Nov 1, 2015
David Berkey Individual Corporate Director Apr 1, 2019
Ryan Gadia Individual Corporate OfficerCfo Nov 1, 2018
Marisela Lawson Individual Corporate Director Apr 1, 2019
Luis Gutierrez Individual Corporate DirectorVice Chairperson Sep 1, 2016
Linda Simon-Price Individual Corporate OfficerInterim Cmo Dec 1, 2021
W-2 Managing EmployeeInterim Cmo Dec 1, 2021
Rafael Robles Individual Corporate Director Apr 1, 2021
Carmen Vergara Individual Corporate OfficerCoo Jun 1, 2018
Brian Fredericks Individual Corporate DirectorTreasurer Jun 1, 2017
Daniel C Fulwiler Individual Corporate OfficerCeo Apr 21, 2008
W-2 Managing EmployeeCeo Apr 21, 2008

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1669812582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 S RICHMOND ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606292821",
            "telephone_number": "773-584-6202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 S RICHMOND ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606292821",
            "telephone_number": "773-584-6202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESPERANZA HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESPERANZA HEALTH CENTERS",
        "enumeration_date": "2013-06-25",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "MCINNES",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING & PATIENT ACCES",
        "authorized_official_telephone_number": "773-640-5785"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Esperanza Health Center at Marquette",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Esperanza Health Center at Marquette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.