NPIMap

Organization Active NPI

Primecare Community Health Inc.

Doing business as PrimeCare Belmont Cragin

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1790247476
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMECARE COMMUNITY HEALTH INC.
Doing business as
PrimeCare Belmont Cragin
Practice address
5635 W Belmont Ave
Chicago, IL 60634-4384
Phone
(773) 736-1830
Fax
(773) 736-1840
NPI assigned
Apr 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Authorized official

Name
Robert Vangilder
Title
Cfo
Phone
(312) 491-5034

Specialties & licenses 1

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

Addresses

Primary practice location

5635 W Belmont Ave
Chicago, IL 60634-4384

Mailing address

PO Box 21844
Belfast, ME 04915-4115
Phone (312) 491-5034

Other names 1

  • PrimeCare Belmont Cragin Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040227000011 IL Part B Supplier - Clinic/Group Practice 6204722077 Receives reassigned benefits from 89 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20190425002906 IL Part A Provider - Federally Qualified Health Center (FQHC) 6204722077 Practice locations: Chicago, IL

Federally qualified health center certification: CCN 781922

Legal name
PRIMECARE COMMUNITY HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 24, 2019
Last certification
Apr 24, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1992 in IL
Enrollment address
5635 W Belmont Ave
Chicago, IL 60634-4384

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2223529Primecare Belmont Cragin Health Center5635 W Belmont Ave, Chicago, IL 60634Provider-performed microscopyMay 6, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Luis Vidal Individual Corporate OfficerBoard Member Jan 1, 2024
Michael H Friedman Individual Corporate DirectorBoard Member Jan 1, 2024
Latonda Davenport Individual Corporate DirectorBoard Member Jan 1, 2024
Jean Schwab Individual Corporate DirectorBoard Member Jul 1, 2021
Lynn Hopkins Individual Corporate OfficerCeo Jul 1, 2021
Jose Silva Individual Corporate OfficerBoard Member Jul 1, 2021
Sonia Talavera Individual Corporate DirectorBoard Member Jul 1, 2021
Shawna Lecuyer Individual Corporate OfficerBoard Member Jan 1, 2024
Randall Palmer Individual Corporate DirectorBoard Member Jul 1, 2021
Rosita de la Rosa Individual Corporate DirectorBoard Member Jul 1, 2021
Cheryl Reese Individual Corporate DirectorBoard Member Jul 1, 2021
Marie Pagan Individual Corporate OfficerBoard Member Jan 1, 2024
Luis Reyes Individual Corporate DirectorBoard Member Jul 1, 2021
Perpetua Ruiz Individual Corporate OfficerBoard Member Jan 1, 2024
Michael Holtrop Individual Corporate OfficerCfo Dec 1, 2021
W-2 Managing EmployeeCfo Dec 1, 2021
Victoria Levin Sniegowski Individual Corporate OfficerBoard Member Jan 1, 2024
Robert J Cech Individual Corporate DirectorBoard Member Jul 1, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1790247476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21844",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154115",
            "telephone_number": "312-491-5034",
            "fax_number": "312-491-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5635 W BELMONT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606344384",
            "telephone_number": "773-736-1830",
            "fax_number": "773-736-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE COMMUNITY HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "VANGILDER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "312-491-5034"
    },
    "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": "PrimeCare Belmont Cragin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PrimeCare Belmont Cragin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.