NPIMap

Organization Active NPI

Erie Family Health Center, Inc

Doing business as Erie Westside Family Health

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1770770273
Registry record updated Dec 15, 2008
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
Doing business as
Erie Westside Family Health
Practice address
646 N Lawndale Ave
Chicago, IL 60624-1254
Phone
(312) 432-7423
NPI assigned
Sep 28, 2007
Last updated
Dec 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2008

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

Authorized official

Name
Miss Gabriela Norena
Title
Billing Department Supervisor
Phone
(312) 432-7444

Specialties & licenses 1

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

Addresses

Primary practice location

646 N Lawndale Ave
Chicago, IL 60624-1254

Mailing address

1701 W Superior St
Chicago, IL 60622-5646
Phone (312) 666-3494

Other identifiers 2

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

Other names 1

  • Erie Westside Family Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080728000431 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537050422 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770770273. Details of each certification follow.

Federally qualified health center certification: CCN 141086

Legal name
ERIE FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 15, 2008
Last certification
Sep 15, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2008 in IL
Enrollment address
646 N Lawndale Ave
Chicago, IL 60624-1254

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Erie Family Health Cent18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

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 DirectorSecretary Dec 1, 2007
Brian Marsella Individual Corporate DirectorChair Aug 1, 2007
Lee Francis Individual Corporate OfficerPresident and Ceo Jul 1, 2013
Stephanie Smith Individual Corporate OfficerCfo Oct 13, 2025
W-2 Managing EmployeeCfo Oct 13, 2025
Caroline M Hoke Individual Corporate OfficerChief Clinical Officer Mar 6, 2018
William Kistner Individual Corporate DirectorTreasurer May 23, 2007
Mychel Owens Individual W-2 Managing EmployeeManaged Care Manager Oct 22, 2022
Amy Valukas Individual Corporate OfficerCoo Jul 3, 2016
Carolyn a Dickens Individual Corporate OfficerVice 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.

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229299200000",
    "number": "1770770273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225646",
            "telephone_number": "312-666-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "646 N LAWNDALE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606241254",
            "telephone_number": "312-432-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2008-12-15",
        "status": "A",
        "authorized_official_last_name": "NORENA",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "BILLING DEPARTMENT SUPERVISOR",
        "authorized_official_telephone_number": "312-432-7444",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "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",
            "identifier": "748480",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Erie Westside Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.