NPIMap

Organization Active NPI

Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Arlington Heights, IL
National Provider Identifier
1780879023
Registry record updated Dec 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
E9983542805 Issued in IL
Legal business name
ACCESS COMMUNITY HEALTH NETWORK
Practice address
1120 N Arlington Heights Rd
Arlington Heights, IL 60004-4767
Phone
(847) 342-1554
Fax
(847) 342-1711
NPI assigned
Sep 10, 2007
Last updated
Dec 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2018

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

Authorized official

Name
Donna Thompson
Title
Ceo
Phone
(312) 526-2051

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Federally Qualified Health Center (FQHC) 261QF0400X E9983542805 IL Primary

Addresses

Primary practice location

1120 N Arlington Heights Rd
Arlington Heights, IL 60004-4767

Mailing address

600 W Fulton
Suite 200
Chicago, IL 60661-1262
Phone (312) 526-2051

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000985 IL Part B Supplier - Clinic/Group Practice 9537076112 Receives reassigned benefits from 512 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Chicago Heights, IL; Cicero, IL; Des Plaines, IL; Evanston, IL; Heights, IL; Melrose Park, IL; Summit, IL…
O20071023000292 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537076112 Practice locations: Arlington Heights, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780879023. Details of each certification follow.

Federally qualified health center certification: CCN 141046

Legal name
ACCESS COMMUNITY HEALTH NETWORK
Doing business as
ACCESS NORTHWEST FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 20, 2007
Last certification
Nov 20, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 11, 1984 in IL
Enrollment address
1120 N Arlington Heights Rd
Arlington Heights, IL 60004-4767
Related CCNs
141867

National Provider Directory

National Provider Directory
Tax ID family
Access Community Network29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Perla Herrera Individual Corporate Director Sep 1, 2013
Donna Thompson Individual Corporate OfficerCeo Jul 1, 1995 100%
Corporate DirectorCeo Jul 1, 1995 100%
W-2 Managing EmployeeCeo Jul 1, 1995 100%
David Wise Individual Corporate Director Jul 1, 2010
Thomas P Fitzgibbon Individual Corporate Director Mar 1, 2013
Delphine Goree Individual Corporate Director Jul 1, 2010
Virginia Oviedo Individual Corporate Director Apr 1, 2011
Julio Morejon Individual Corporate Director Jul 1, 2019
Denise Kitchen Individual Corporate Director Jun 1, 2007
Patricia Bobb Individual Corporate Director Jul 10, 2010
Donna Simmons Individual Corporate Director Mar 1, 2000
Daniela Levitt Individual Corporate Director Jul 1, 2010
Peter McNerney Individual Corporate Director Feb 1, 2015
Terry Brown Individual Corporate Director Mar 1, 2000
Elizabeth Perez Individual W-2 Managing Employee Sep 1, 2017
Matthew Berkley Individual Corporate Director Jun 1, 2018
Marilyn Scott Individual Corporate Director Mar 1, 2013
Robert Sheesly Individual Corporate Director Jul 1, 2010
Lilia Gonzalez Individual Corporate Director Jan 1, 2018
Derrick Tung Individual Corporate Director Jun 1, 2010
Miriam Mobley-Smith Individual Corporate Director Sep 1, 2017
Erin Starkey Individual Corporate Director Jul 1, 2010
Ryan Hart Individual Corporate Director Mar 1, 2013
Sharon Gibson Individual Corporate Director Jan 1, 2018
Charles Deshazer Individual Corporate Director Apr 1, 2011
Adrienne Watson Individual Corporate Director Mar 1, 2000

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1780879023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W FULTON",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606611262",
            "telephone_number": "312-526-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N ARLINGTON HEIGHTS RD",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600044767",
            "telephone_number": "847-342-1554",
            "fax_number": "847-342-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-526-2051"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": "E9983542805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington Heights, IL

Sources for this page

Verify at the official NPI Registry.