NPIMap

Organization Active NPI

Progressive Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
National Provider Identifier
1720153653
Registry record updated Jan 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC.
Practice address
3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Phone
(414) 935-8000
Fax
(414) 344-3396
NPI assigned
Nov 24, 2006
Last updated
Jan 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2017

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

Authorized official

Name
Candice Cole
Title
Cfo
Phone
(414) 935-8000

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

3522 W Lisbon Ave
Milwaukee, WI 53208-1953

Mailing address

PO Box 080257
Milwaukee, WI 53208-8004
Phone (414) 935-8000

Other names 1

  • Lisbon Avenue Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000358 WI Part B Supplier - Clinic/Group Practice 2466366059 Receives reassigned benefits from 59 practitioners
3 other NPIs on this enrollment
Practice locations: Milwaukee, WI
O20101012001304 WI Part A Provider - Federally Qualified Health Center (FQHC) 2466366059 Practice locations: Milwaukee, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720153653. Details of each certification follow.

Federally qualified health center certification: CCN 521821

Legal name
PROGRESSIVE COMMUNITY HEALTH CENTERS INC
Doing business as
LISBON AVENUE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 27, 2001
Last certification
Feb 27, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 14, 2011 in WI
Enrollment address
3522 W Lisbon Ave
Milwaukee, WI 53208-1953

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

1218 W Kilbourn Ave
Ste 124
Milwaukee, WI 53233
Phone (414) 291-2626

1452 N 7th St
Milwaukee, WI 53205
Phone (414) 287-0919

1452 N 7th St
Fl 2
Milwaukee, WI 53205
Phone (414) 935-8000

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Janice Harrell Individual Corporate Director Aug 18, 2015
Barbara Zak Individual W-2 Managing EmployeeCoo Mar 6, 2018
Albert Cooper Individual Corporate Director Oct 25, 2016
John a Grandberry Individual Corporate DirectorChair Aug 28, 2018
Candice L Cole Individual W-2 Managing EmployeeCfo Aug 9, 2014

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485302400000",
    "number": "1720153653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 080257",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532088004",
            "telephone_number": "414-935-8000",
            "fax_number": "414-755-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081953",
            "telephone_number": "414-935-8000",
            "fax_number": "414-344-3396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE COMMUNITY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2017-01-25",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "414-935-8000"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lisbon Avenue Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.