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Organization Active NPI

PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Melrose Park, IL
National Provider Identifier
1720104573
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
011 Issued in IL
Legal business name
PCC COMMUNITY WELLNESS CENTER
Practice address
1111 Superior St
Suite 207
Melrose Park, IL 60160-4138
Phone
(708) 406-3040
Fax
(708) 406-3059
NPI assigned
Mar 22, 2007
Organization subpart
No

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Practitioners 91

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

View all 91

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081121000308 IL Part A Provider - Federally Qualified Health Center (FQHC) 1557270139 Practice locations: Melrose Park, IL

Federally qualified health center certification: CCN 141091

Legal name
PCC COMMUNITY WELLNESS CENTER
Doing business as
PCC MELROSE PARK FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2009
Last certification
Jan 8, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1111 Superior St
Ste 101
Melrose Park, IL 60160-4100

All disclosed owners & managing parties 12

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
Alyssa Sianghio Individual Corporate OfficerPresident and Ceo Apr 10, 2024 100%
W-2 Managing EmployeePresident and Ceo Apr 10, 2024 100%
John McDonnell Individual Corporate DirectorBoard Member Jul 26, 2011
Patricia Ford Individual Corporate DirectorBoard Member Aug 25, 2009
Ron Austin Individual Corporate DirectorBoard Member Jun 8, 2001
Nilsa Campos Individual Corporate OfficerChief Operating Officer Sep 1, 2021 100%
W-2 Managing EmployeeChief Operating Officer Sep 1, 2021 100%
Velda Brunner Individual Corporate DirectorBoard Member Nov 29, 2015
Hiren Patel Individual Corporate OfficerChief Financial Officer Sep 11, 2024 100%
W-2 Managing EmployeeChief Financial Officer Sep 11, 2024 100%
Jerrard D Walker Individual Corporate OfficerChief Population Health Officer Mar 8, 2021 100%
W-2 Managing EmployeeChief Population Health Officer Mar 8, 2021 100%
Sara Hogue Individual Corporate OfficerChief Performance Improvement Offic Nov 4, 2019 100%
W-2 Managing EmployeeChief Performance Improvement Offic Nov 4, 2019 100%
Paul Luning Individual Corporate OfficerChief Medical Officer Sep 17, 2007 100%
W-2 Managing EmployeeChief Medical Officer Apr 16, 2012 100%
Kathleen Hand Individual W-2 Managing Employee Nov 10, 2008
Kenneth M Blair Individual Corporate DirectorBoard Treasurer Jul 31, 1992

All facility ownership & control disclosures 2

Medicare enrollment files

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

FacilityTypeRoleSince
PCC Dr Tong Health CenterOak Park, IL, CCN 141034 Federally qualified health center Other (100%) Sep 15, 2004
PCC Walk-in Wellness Center at West Suburban Medical CenterOak Park, IL, CCN 781802 Federally qualified health center Other (100%) Sep 15, 2004

National Provider Directory

National Provider Directory
Tax ID family
PCC Community Wellness Ctr21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

1111 Superior St
Ste 101
Melrose Park, IL 60160
Phone (708) 344-2161

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Robert J Urso
Title
President and Ceo
Phone
(708) 383-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 011 IL Primary

Addresses

Primary practice location

1111 Superior St
Suite 207
Melrose Park, IL 60160-4138

Mailing address

1111 Superior St
Suite 207
Melrose Park, IL 60160-4138
Phone (708) 406-3040

Other names 1

  • PCC Melrose Park Family Health Center Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720104573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 SUPERIOR ST",
            "address_2": "SUITE 207",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601604138",
            "telephone_number": "708-406-3040",
            "fax_number": "708-406-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SUPERIOR ST",
            "address_2": "SUITE 207",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601604138",
            "telephone_number": "708-406-3040",
            "fax_number": "708-406-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCC COMMUNITY WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "URSO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "708-383-9786"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": "011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCC Melrose Park Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melrose Park, IL

Sources for this page

Verify at the official NPI Registry.