NPIMap

Organization Active NPI

Solvera Healthcare Center Inc

  • Federally Qualified Health Center (FQHC)
  • Galesburg, IL
National Provider Identifier
1760113104
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOLVERA HEALTHCARE CENTER INC
Practice address
256 S Soangetaha Rd
Galesburg, IL 61401-5586
Phone
(309) 233-2836
NPI assigned
Jun 17, 2022
Organization subpart
Yes
Parent organization
SOLVERA HEALTHCARE CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Authorized official

Name
Patrick Caplis
Title
Ceo
Phone
(309) 886-9172

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physical Therapy Clinic/Center 261QP2000X
Radiology Clinic/Center 261QR0200X
Clinical Medical Laboratory 291U00000X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

256 S Soangetaha Rd
Galesburg, IL 61401-5586

Mailing address

PO Box 9727
Peoria, IL 61612-9727

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220711002297 IL Part B Supplier - Clinic/Group Practice 4981007226 Receives reassigned benefits from 6 practitioners
Practice locations: Galesburg, IL
O20241008003057 IL Part A Provider - Federally Qualified Health Center (FQHC) 4981007226 Practice locations: Galesburg, IL

Federally qualified health center certification: CCN C41033

Legal name
SOLVERA HEALTHCARE CENTER INC
Doing business as
SOLVERA HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 7, 2024
Last certification
Sep 7, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 2021 in IL
Enrollment address
256 S Soangetaha Rd
Galesburg, IL 61401

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Part of
Solvera Healthcare Center

Locations

2619 W Heading Ave
Ste 303
West Peoria, IL 61604

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Daniel Kerns Individual Corporate DirectorBoard Member Sep 1, 2022
Douglas Shaw Individual Corporate DirectorBoard Member Mar 22, 2021
Sarai Marchan Individual Corporate DirectorBoard Member Mar 22, 2021
Chukwuka a Chidi Individual Corporate OfficerChief Financial Officer Dec 1, 2023
Robin Henry Individual Corporate OfficerChief Operating Officer Dec 3, 2023
Patrick Caplis Individual Corporate OfficerChief Executive Officer Aug 1, 2021
W-2 Managing EmployeeChief Executive Officer Aug 1, 2021
Michael Miller Individual Corporate DirectorBoard Member Mar 22, 2021
Mary Weyeneth Individual Corporate DirectorBoard Member Jul 1, 2021
Alison Millinger Individual Corporate DirectorBoard Member Sep 1, 2021
Alexander Shaw Individual Corporate DirectorBoard Member Aug 1, 2022
Jerry Mitchell Individual Corporate DirectorBoard Member Apr 1, 2023
Zahida Mughal Individual Corporate OfficerChief Medical Officer Jan 1, 2024
Jeffrey Gengenbach Individual Corporate DirectorBoard Member Oct 1, 2023
Ann Johnston-Rae Individual Corporate DirectorBoard Member Jun 21, 2022

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Solvera HealthPeoria, IL, CCN C41023 Federally qualified health center Other (100%) Mar 22, 2021

Owned or controlled facilities with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1760113104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9727",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616129727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 S SOANGETAHA RD",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614015586",
            "telephone_number": "309-233-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLVERA HEALTHCARE CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOLVERA HEALTHCARE CENTER INC",
        "enumeration_date": "2022-06-17",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "CAPLIS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-886-9172"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "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": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

Verify at the official NPI Registry.