NPIMap

Organization Active NPI

Lawndale Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1831590421
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LAWNDALE CHRISTIAN HEALTH CENTER
Practice address
3219 W Carroll Ave
Chicago, IL 60624-2031
Phone
(872) 588-3000
NPI assigned
Sep 15, 2014
Last updated
Jul 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
Karen Renee Johnson
Title
Asst Dir of Patient Accounting
Phone
(872) 588-3000

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Counselor 101Y00000X NU
Clinical Psychologist 103TC0700X NU
Dentist 122300000X NU
Nutritionist 133N00000X NU
Optometrist 152W00000X NU
Licensed Practical Nurse 164W00000X NU

Addresses

Primary practice location

3219 W Carroll Ave
Chicago, IL 60624-2031

Mailing address

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone (872) 588-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141114001299 IL Part A Provider - Federally Qualified Health Center (FQHC) 2264336346 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831590421. Details of each certification follow.

Federally qualified health center certification: CCN 781828

Legal name
LAWNDALE CHRISTIAN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 14, 2014
Last certification
Nov 14, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1984 in IL
Enrollment address
3219 West Carroll Avenue
Chicago, IL 60624-2031

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Lawndale Christian Health10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

3219 W Carroll Ave
Chicago, IL 60624
Phone (872) 588-3000

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Rochelle Foster Individual Corporate DirectorVice Chair Jan 1, 2017
William D Clapp Individual Corporate Director Feb 1, 2015
Sara Demateo Individual Corporate DirectorSecretary Dec 1, 2016
Carl E Lambert Individual Corporate Director Jan 1, 2020
George Clopton Individual Corporate Director Feb 1, 2015
Anne Gordan Individual Corporate Director Feb 1, 2015
Jeanette Park Lee Individual Corporate Director Feb 1, 2017
Jonathan Wildt Individual Corporate OfficerChief Operating Officer Nov 6, 2013
Robert David Castaneda Individual Corporate DirectorBoard Chair Feb 1, 2015
Dave Doig Individual Corporate Director Jan 1, 2014
Karen Johnson Individual W-2 Managing EmployeeAssistant Director of Patient Accts Jul 1, 2008
Christopher Dons Individual Corporate OfficerCheif Financial Officer Nov 6, 2013
James Brooks Individual Corporate OfficerChief Executive Officer Jan 3, 2022
W-2 Managing EmployeeChief Executive Officer Mar 4, 2013

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lawndale Christian Health Center Archer AvenueChicago, IL, CCN 141107 Federally qualified health center Operational/Managerial Control Jul 1, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1831590421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3219 W CARROLL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606242031",
            "telephone_number": "872-588-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWNDALE CHRISTIAN HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-15",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "ASST DIR OF PATIENT ACCOUNTING",
        "authorized_official_telephone_number": "872-588-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.