NPIMap

Organization Active NPI

Community Health & Emergency Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cairo, IL
National Provider Identifier
1710979588
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
Practice address
13245 Kessler Rd
Cairo, IL 62914
Phone
(618) 734-4400
NPI assigned
Aug 18, 2005
Last updated
Aug 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Authorized official

Name
Mr. Frederick L Bernstein
Title
Ceo
Phone
(618) 457-0450

Specialties & licenses 1

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

Addresses

Primary practice location

13245 Kessler Rd
Cairo, IL 62914

Mailing address

PO Box 3008
Carbondale, IL 62902-3008
Phone (618) 457-0450

Other identifiers 3

IdentifierTypeStateIssuer
CI2819OtherILRRMEDICARE/PALMETTO GBA
CA5418OtherILRRMEDICARE/PALMETTO GBA
CB1159OtherILRRMEDICARE/PALMETTO GBA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040330000765 IL Part B Supplier - Clinic/Group Practice 0749194702 Receives reassigned benefits from 18 practitioners
Practice locations: Pulaski, IL; Tamms, IL; Harrisburg, IL; Golconda, IL; Carmi, IL; Carbondale, IL; Cairo, IL; Elizabethtown, IL
O20101012001345 IL Part A Provider - Federally Qualified Health Center (FQHC) 0749194702 Practice locations: Cairo, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710979588. Details of each certification follow.

Federally qualified health center certification: CCN 141813

Legal name
COMMUNITY HEALTH & EMERGENCY SERVICES INC
Doing business as
CAIRO MEGA CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 29, 1981 in IL
Enrollment address
13245 Kessler Rd
Cairo, IL 62914-3101

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

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
14D2055232Cairo Mega Clinic13245 Kessler Rd, Cairo, IL 62914Certificate of waiverMar 6, 2027

National Provider Directory

National Provider Directory

Locations

1 Ferrell Rd
Rosiclare, IL 62982
Phone (618) 285-6191

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Katrina W Cerutti Individual Corporate OfficerBoard Member Nov 17, 2009
Joseph M Hancock Individual Corporate OfficerChairman Nov 28, 2000
Josie Eason Individual Corporate OfficerBoard Member Jul 31, 2007
Elida Phifer Individual Corporate OfficerBoard Member Nov 9, 2004
Frederick L Bernstein Individual Corporate DirectorCeo Aug 13, 2010
W-2 Managing Employee Aug 13, 2010
Cordell McGoy Individual Corporate OfficerBoard Member Jan 30, 2014
Charles Soward Individual Corporate OfficerTreasurer Jul 22, 1996

Practitioners & affiliated clinicians

Practitioners 51

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 51

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1710979588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3008",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023008",
            "telephone_number": "618-457-0450",
            "fax_number": "618-457-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13245 KESSLER RD",
            "city": "CAIRO",
            "state": "IL",
            "postal_code": "62914",
            "telephone_number": "618-734-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH & EMERGENCY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "BERNSTEIN",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-457-0450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE/PALMETTO GBA",
            "identifier": "CI2819",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE/PALMETTO GBA",
            "identifier": "CA5418",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE/PALMETTO GBA",
            "identifier": "CB1159",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cairo, IL

Sources for this page

Verify at the official NPI Registry.