NPIMap

Organization Active NPI

County of Lake

  • Federally Qualified Health Center (FQHC)
  • Libertyville, IL
National Provider Identifier
1679900229
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNTY OF LAKE
Practice address
18698 W Peterson Rd
Libertyville, IL 60048-1052
Phone
(847) 377-8510
NPI assigned
Sep 27, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Sam Johnson
Title
Deputy Executive Director
Phone
(847) 377-8000

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 6

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

Other NPIs on the same Medicare enrollment 24

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 42

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

View all 42

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 46

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

View all 46

Medicare participation

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

Federally qualified health center certification: CCN 781831

Medicare enrollment files
Legal name
COUNTY OF LAKE
Doing business as
LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2015
Last certification
Jan 9, 2015
Ownership / control type
Non-profit – corporation
Organization structure
OtherNon-profit
Enrollment address
18698 W Peterson Rd
Libertyville, IL 60048-1052

All disclosed owners & managing parties 3

Medicare enrollment files

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

NameRoleSinceShare
Natalie D Basgall Individual W-2 Managing EmployeeRevenue Cycle Manager Mar 24, 2025 5%
Andrea Cooper Individual Corporate DirectorDirector of Finance and Admin Cfo Jul 15, 2024
W-2 Managing EmployeeDirector of Finance and Admin Cfo Jul 15, 2024
Operational/Managerial ControlDirector of Finance and Admin Cfo Jul 15, 2024
County of Lake Organization, Waukegan, IL Operational/Managerial Control Dec 1, 2014

All facility ownership & control disclosures 6

Medicare enrollment files

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

FacilityTypeRoleSince
County of LakeRound Lake Beach, IL, CCN 141913 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 21, 2004
Lake County Health DepartmentNorth Chicago, IL, CCN 141911 Federally qualified health center Operational/Managerial Control Sep 13, 2004
Lake County Health Department and Community Health CenterWaukegan, IL, CCN 141910 Federally qualified health center Operational/Managerial Control May 31, 2000
Lake County Health Department and Community Health CenterZion, IL, CCN 141912 Federally qualified health center Operational/Managerial Control Dec 1, 2000
Lake County Health Department and Community Health CenterHighland Park, IL, CCN 141096 Federally qualified health center Operational/Managerial Control Jun 26, 2006
Lake County Health Department and Community Health CenterWaukegan, IL, CCN 141122 Federally qualified health center Operational/Managerial Control Mar 1, 2010

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040116000192 IL Part B Supplier - Clinic/Group Practice 7214838861 Receives reassigned benefits from 148 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waukegan, IL; Zion, IL; Vernon Hills, IL; Round Lake Park, IL; Round Lake Beach, IL; Round Lake, IL; Park City, IL; North Chicago, IL…
O20141126001644 IL Part a Provider - Federally Qualified Health Center (FQHC) 7214838861 Practice locations: Libertyville, IL

National Provider Directory

National Provider Directory
Tax ID family
Lake County Mental Heal T (45 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

18698 W Peterson Rd
Libertyville, IL 60048-1052

Mailing address

3010 Grand Ave
Waukegan, IL 60085-2321
Phone (847) 377-8000

Other names 1

NPPES NPI Registry
  • Lake County Health Department and Community Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 31, 2026.

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1679900229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18698 W PETERSON RD",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481052",
            "telephone_number": "847-377-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-27",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "DEPUTY EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "847-377-8000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake County Health Department and Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.