NPIMap

Organization Active NPI

Lawndale Christian Health Center

  • Community/Retail Pharmacy
  • Chicago, IL
National Provider Identifier
1679680235
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054013315 Issued in IL
Legal business name
LAWNDALE CHRISTIAN HEALTH CENTER
Practice address
3910 W Ogden Ave
Chicago, IL 60623-2470
Phone
(872) 588-3256
Fax
(872) 588-3251
NPI assigned
Aug 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
Karen Johnson
Title
Asst Dir of Patient Accounting
Phone
(872) 588-3062

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 054013315 IL Primary

Addresses

Primary practice location

3910 W Ogden Ave
Chicago, IL 60623-2470

Mailing address

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone (872) 588-3000

Other identifiers 1

IdentifierTypeStateIssuer
2023743OtherPK

Other names 1

  • LAWNDALE CHRISTIAN HEALTH CENTER PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180507001811 IL Part B Supplier - Pharmacy 2264336346 Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Lawndale Christian Health10 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

4696 Paysphere Cir
Chicago, IL 60674

3910 W Ogden Ave
Chicago, IL 60623
Phone (872) 588-3250

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lawndale Christian Health Center Archer AvenueChicago, IL, CCN 141107 Federally qualified health center Operational/Managerial Control Jul 1, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 184

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

View all 184

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1679680235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232470",
            "telephone_number": "872-588-3256",
            "fax_number": "872-588-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWNDALE CHRISTIAN HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "ASST DIR OF PATIENT ACCOUNTING",
        "authorized_official_telephone_number": "872-588-3062"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054013315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2023743",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAWNDALE CHRISTIAN HEALTH CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LAWNDALE CHRISTIAN HEALTH CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.