NPIMap

Organization Active NPI

Christian Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lansing, IL
National Provider Identifier
1750619680
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRISTIAN COMMUNITY HEALTH CENTER
Practice address
2320 Thornton Lansing Rd
Lansing, IL 60438-2116
Phone
(773) 233-4100
Fax
(773) 233-4055
NPI assigned
Dec 4, 2009
Last updated
Dec 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Authorized official

Name
Sanara Leake
Title
Revenue Cycle Manager
Phone
(773) 233-4100

Specialties & licenses 1

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

Addresses

Primary practice location

2320 Thornton Lansing Rd
Lansing, IL 60438-2116

Mailing address

PO Box 288080
Chicago, IL 60628-8080
Phone (773) 233-4100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000515 IL Part B Supplier - Clinic/Group Practice 4284533183 Receives reassigned benefits from 27 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Calumet City, IL; Chicago, IL; Lansing, IL; South Holland, IL
O20230727003252 IL Part A Provider - Federally Qualified Health Center (FQHC) 4284533183 Practice locations: Lansing, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750619680. Details of each certification follow.

Federally qualified health center certification: CCN C41001

Legal name
CHRISTIAN COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 20, 2023
Last certification
Jul 20, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 2023 in IL
Enrollment address
2320 Thornton Lansing Rd
Lansing, IL 60438-2116

Other NPIs with the same Medicare PAC ID 3

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.

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
14D2338965Christian Community Health Center2320 Thornton-Lansing Rd, Lansing, IL 60438Provider-performed microscopyFeb 19, 2028

National Provider Directory

National Provider Directory

Locations

364 Torrence Ave
Calumet City, IL 60409
Phone (708) 868-9457

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Latoya Dixon Individual Corporate DirectorSecretary Jan 1, 2015
Dana Garner Individual Corporate DirectorTreasurer Jan 1, 2015
Sanara Leake Individual W-2 Managing EmployeeRevenue Cycle Manager Aug 3, 2021
Jetuan Grayson Individual Corporate DirectorBoard Member Jan 1, 2015
Kenneth Burnett Individual Corporate OfficerChief Executive Officer Jan 1, 2015
Will Cobbs Individual Corporate DirectorBoard Chairman Jan 1, 2015

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672272000000",
    "number": "1750619680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 288080",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606288080",
            "telephone_number": "773-233-4100",
            "fax_number": "773-233-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 THORNTON LANSING RD",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604382116",
            "telephone_number": "773-233-4100",
            "fax_number": "773-233-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-04",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A",
        "authorized_official_last_name": "LEAKE",
        "authorized_official_first_name": "SANARA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "773-233-4100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, IL

Sources for this page

Verify at the official NPI Registry.