County of Lake

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COUNTY OF LAKE

Doing business as

Lake County Health Department and Community Health Center

Practice address

224 W Clarendon Dr
Round Lake Beach, IL 60073-1896

Phone

(847) 984-5100

Fax

(847) 984-5120

NPI assigned

Jul 1, 2006

Last updated

Aug 31, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sam Johnson

Title

Deputy Executive Director

Phone

(847) 377-8000

Specialties & licenses 1

Addresses

Other names 1

• LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750310884. Details of each certification follow.

• CCN 141913 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 141913

Legal name

COUNTY OF LAKE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 1, 2000

Last certification

Dec 1, 2000

Ownership / control type

For profit – corporation

Organization structure

GovernmentNon-profit

Enrollment address

224 W Clarendon Dr
Round Lake Beach, IL 60073-1896

Other NPIs with the same Medicare PAC ID 10

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

• County of Lake

  dba Lake County Health Department and Community Health Center

  • Public Health or Welfare Agency
  • Waukegan, IL
  • NPI 1013920750

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Zion, IL
  • NPI 1023047164

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Chicago, IL
  • NPI 1083643118

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1174552293

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1235453309

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Highland Park, IL
  • NPI 1285663328

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Round Lake, IL
  • NPI 1639588254

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Libertyville, IL
  • NPI 1679900229

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department/Community Health Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waukegan, IL
  • NPI 1720290091

  7214838861

  Same PAC ID
• County of Lake

  dba Lake County Health Department/Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1992155022

  7214838861

  Same PAC ID

Other NPIs on the same Medicare enrollment 24

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

• County of Lake

  dba Lake County Health Department and Community Health Center

  • Public Health or Welfare Agency
  • Waukegan, IL
  • NPI 1013920750

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Zion, IL
  • NPI 1023047164

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
  • NPI 1053623637

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Chicago, IL
  • NPI 1083643118

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1174552293

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
  • NPI 1174745160

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1235453309

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Public Health or Welfare Agency
  • Waukegan, IL
  • NPI 1255342457

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Highland Park, IL
  • NPI 1285663328

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1376717702

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
  • NPI 1477765741

  O20040116000192

  Same enrollment
• County of Lake

  dba Lake County Health Dept and Community Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Zion, IL
  • NPI 1538380647

  O20040116000192

  Same enrollment

Tax ID family

Lake County Health Dept43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

• County of Lake

  dba Lake County Health Department and Community Health Center

  • Public Health or Welfare Agency
  • Waukegan, IL
  • NPI 1013920750
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Zion, IL
  • NPI 1023047164
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
  • NPI 1053623637
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Chicago, IL
  • NPI 1083643118
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1174552293
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
  • NPI 1174745160
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1235453309
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Public Health or Welfare Agency
  • Waukegan, IL
  • NPI 1255342457
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Highland Park, IL
  • NPI 1285663328
  NPD tax ID
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waukegan, IL
  • NPI 1356888515
  NPD tax ID
• County of Lake

  dba Nineteenth Judicial Circuit

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Vernon Hills, IL
  • NPI 1417243288
  NPD tax ID
• County of Lake

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
  • NPI 1457272585
  NPD tax ID

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 10

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

• County of Lake

  dba Lake County Health Department and Community Health Center

  • Public Health or Welfare Agency
  • Waukegan, IL
  • NPI 1013920750

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Zion, IL
  • NPI 1023047164

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Chicago, IL
  • NPI 1083643118

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1174552293

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1235453309

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Highland Park, IL
  • NPI 1285663328

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Round Lake, IL
  • NPI 1639588254

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Libertyville, IL
  • NPI 1679900229

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department/Community Health Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waukegan, IL
  • NPI 1720290091

  5% Or Greater Direct Ownership Interest

  CMS ownership
• County of Lake

  dba Lake County Health Department/Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1992155022

  5% Or Greater Direct Ownership Interest

  CMS ownership

All facility ownership & control disclosures 6

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

Owned or controlled facilities with NPI records 6

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

• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Zion, IL
  • NPI 1023047164

  Operational/Managerial Control

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Chicago, IL
  • NPI 1083643118

  Operational/Managerial Control

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1174552293

  Operational/Managerial Control

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1235453309

  Operational/Managerial Control

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Highland Park, IL
  • NPI 1285663328

  Operational/Managerial Control

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Libertyville, IL
  • NPI 1679900229

  Operational/Managerial Control

  CMS ownership

Facilities with the same owner 6

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

• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Zion, IL
  • NPI 1023047164

  County of Lake

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • North Chicago, IL
  • NPI 1083643118

  County of Lake

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1174552293

  County of Lake

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Waukegan, IL
  • NPI 1235453309

  County of Lake

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Highland Park, IL
  • NPI 1285663328

  County of Lake

  CMS ownership
• County of Lake

  dba Lake County Health Department and Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Libertyville, IL
  • NPI 1679900229

  County of Lake

  CMS ownership

Practitioners 9

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.

• Lundon Shari Brown, DNP, FNP-C

  • Nurse Practitioner
  • Waukegan, IL
  • NPI 1114367562
  NPD
• Kathryn M Ellis, APRN, DNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1689223232
  NPD
• Kerrie Danielle Fish, LCSW, CADC

  • Clinical Social Worker
  • Waukegan, IL
  • NPI 1669730198
  NPD
• Jauren D Kelly, PSY.D.

  • Clinical Psychologist
  • Libertyville, IL
  • NPI 1831110220
  NPD
• Laura Ann Kresch, DNP, APNP, FNP-BC

  • Family Nurse Practitioner
  • Highland Park, IL
  • NPI 1679091185
  NPD
• Betsy K Luka, M.D.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1417202268
  NPD
• Daram Reddy, MD

  • Psychiatry Physician
  • Waukegan, IL
  • NPI 1609895515
  NPD
• Mamerto S Villamonte II, D.D.S.

  • Dentist
  • Elmwood Park, IL
  • NPI 1376532119
  NPD
• Nikhil Pillai, MD

  • Psychiatry Physician
  • Albuquerque, NM
  • NPI 1023505773
  NPD

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1750310884",
    "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": "224 W CLARENDON DR",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600731896",
            "telephone_number": "847-984-5100",
            "fax_number": "847-984-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "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"
        }
    ]
}

• Chiro One Wellness Center of Round Lake Beach LLC
• Michelle Chisenhall, RDH
• Christina M Circo, RPH
• Consumate Dental P.C
• Patrick Dene Cornet
• Michelle Crutcher, RDH
• Dac Dental PC (Rollins Family Dental Center)
• Daniel & Max, LLC
• Henry Oa Darko
• Renita Dercel Davis, MSW, MED

• Federally Qualified Health Center (FQHC) in Round Lake Beach, IL
• Providers in Round Lake Beach, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.