NPIMap

Organization Active NPI

Chestnut Health Systems, Inc

Doing business as Chestnut Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Bloomington, IL
National Provider Identifier
1790055952
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHESTNUT HEALTH SYSTEMS, INC
Doing business as
Chestnut Family Health Center
Practice address
702 W Chestnut St
Bloomington, IL 61701-2814
Phone
(309) 557-1400
Fax
(309) 557-1461
NPI assigned
Jan 5, 2012
Last updated
Mar 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Megan Marie Taylor
Title
Managed Care Supervisor
Phone
(888) 924-3786

Specialties & licenses 1

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

Addresses

Primary practice location

702 W Chestnut St
Bloomington, IL 61701-2814

Mailing address

1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Other practice location 1

720 W Chestnut St
Bloomington, IL 61701-2814
Phone (309) 557-1400

Other names 1

  • Chestnut Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121108000280 IL Part A Provider - Federally Qualified Health Center (FQHC) 1052393063 Practice locations: Bloomington, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790055952. Details of each certification follow.

Federally qualified health center certification: CCN 141178

Legal name
CHESTNUT HEALTH SYSTEMS INC
Doing business as
CHESTNUT FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 19, 2012
Last certification
Dec 19, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 28, 1970 in IL
Enrollment address
702 W Chestnut St
Bloomington, IL 61701-2814

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Victor Armstrong Individual Corporate Director Feb 1, 2001
Puneet Leekha Individual Corporate OfficerCeo Oct 1, 2025
W-2 Managing EmployeeCeo Oct 1, 2025
Al Bowman Individual Corporate DirectorBoard Member Sep 1, 2003
Melissa Woodbury Individual Corporate OfficerCfo Oct 1, 2025
Laura S Haas Individual Corporate OfficerVice Chair May 1, 2007
Judy L Neubrander Individual Corporate Director Dec 1, 2017
Eliazar Mendiola Individual Corporate Director Dec 1, 2015
Mary Ann Ann Webb Individual Corporate DirectorBoard Vice Chairperson May 1, 2008
James F Foley Individual Corporate DirectorBoard Member Dec 1, 2014
Patrick Busch Individual Corporate DirectorBoard Member Jan 1, 2018
Don Hammer Individual Corporate DirectorBoard Secretary Aug 1, 2007
Dennis Wilmsmeyer Individual Corporate Officer Apr 1, 2014

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1790055952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W CHESTNUT ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617012814",
            "telephone_number": "309-557-1400",
            "fax_number": "309-557-1461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 W Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IL",
            "postal_code": "617012814",
            "country_code": "US",
            "telephone_number": "309-557-1400",
            "fax_number": "309-557-1461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHESTNUT HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGED CARE SUPERVISOR",
        "authorized_official_telephone_number": "888-924-3786"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chestnut Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chestnut Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.