NPIMap

Organization Active NPI

Erie Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1760499545
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ERIE FAMILY HEALTH CENTER, INC
Practice address
1701 W Superior St
Chicago, IL 60622-5646
Phone
(312) 432-7394
NPI assigned
Aug 2, 2006
Last updated
Nov 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Authorized official

Name
Dr. Lee Francis, MD, MPHNPI 1114959913
Title
Pesident and Ceo
Phone
(312) 432-7394

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

1701 W Superior St
Chicago, IL 60622-5646

Mailing address

1701 W Superior St
3Rd Floor
Chicago, IL 60622-5646
Phone (312) 432-7394

Other identifiers 3

IdentifierTypeStateIssuer
748480OtherILMEDICARE PART B
1616827OtherILBLUE CROSS BLUE SHIELD PROVIDER NUMBER
F100260003OtherWIMEDICARE PART B PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040322000689 IL Part B Supplier - Clinic/Group Practice 9537050422 Receives reassigned benefits from 396 practitioners
12 other NPIs on this enrollment
Practice locations: Chicago, IL; Evanston, IL; Lake Forest, IL; Waukegan, IL
O20060919000610 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537050422 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20080923000396 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537050422 Practice locations: Chicago, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1760499545. Details of each certification follow.

Federally qualified health center certification: CCN 141035

Legal name
ERIE FAMILY HEALTH CENTER, INC
Doing business as
ERIE JOHNSON SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 28, 2006
Last certification
Nov 28, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 24, 1976 in IL
Enrollment address
1504 S Albany Ave
Chicago, IL 60623-2209
Related CCNs
141829

Federally qualified health center certification: CCN 141829

Legal name
ERIE FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1970 in IL
Enrollment address
1701 W Superior St
Chicago, IL 60622-5646

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

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-2056

2750 W North Ave
Chicago, IL 60647
Phone (312) 432-2767

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Celeste Castillo Individual Corporate OfficerSecretary Dec 1, 2007
Operational/Managerial ControlSecretary Dec 1, 2007
Brian Marsella Individual Corporate DirectorBoard Chair Jul 1, 2011
Operational/Managerial ControlBoard Chair Aug 1, 2007
Lee Francis Individual Corporate OfficerPresident and Ceo Jul 1, 2008
Stephanie Smith Individual Corporate OfficerCfo Oct 13, 2025
Operational/Managerial ControlCfo Oct 13, 2025
Caroline M Hoke Individual Corporate OfficerChief Clinical Officer Mar 6, 2018
Contracted Managing EmployeeChief Clinical Officer Mar 6, 2018
William Kistner Individual Corporate DirectorBoard Treasurer Jul 1, 2002
Corporate OfficerBoard Treasurer Jul 1, 2002
Mychel Owens Individual W-2 Managing EmployeeManager, Managed Care Oct 22, 2022
W-2 Managing EmployeeManaged Care Manager Oct 22, 2022
Amy Valukas Individual W-2 Managing EmployeeChief Population Health Officer Jul 3, 2016
Corporate OfficerChief Population Health Officer Jul 3, 2016
Carolyn a Dickens Individual Corporate OfficerVice Chair Nov 1, 2017
Corporate DirectorVice Chair Nov 1, 2017
Eric Mayeda Individual Corporate DirectorDirector Sep 15, 2004

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 418

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 418

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1760499545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST",
            "address_2": "3RD FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-432-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-432-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "FRANCIS",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "PESIDENT AND CEO",
        "authorized_official_telephone_number": "312-432-7394",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "748480",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PROVIDER NUMBER",
            "identifier": "1616827",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "F100260003",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.