NPIMap

Organization Active NPI

Community Health Improvement Center

Doing business as Crossing Healthcare on Water St

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
National Provider Identifier
1831635770
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH IMPROVEMENT CENTER
Doing business as
Crossing Healthcare on Water St
Practice address
1027 N Water St
Decatur, IL 62523-1022
Phone
(217) 330-5676
Fax
(217) 330-5992
NPI assigned
Jan 17, 2017
Last updated
Feb 10, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH IMPROVEMENT CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Authorized official

Name
Ms. Tanya Andricks
Title
Executive Director/Ceo
Phone
(217) 877-9117

Specialties & licenses 1

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

Addresses

Primary practice location

1027 N Water St
Decatur, IL 62523-1022

Mailing address

320 E Central Ave
Decatur, IL 62521-4665
Phone (217) 877-9117

Other names 1

  • Crossing Healthcare on Water St Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170614001581 IL Part A Provider - Federally Qualified Health Center (FQHC) 4385625342 Practice locations: Decatur, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831635770. Details of each certification follow.

Federally qualified health center certification: CCN 781875

Legal name
COMMUNITY HEALTH IMPROVEMENT CENTER
Doing business as
ELEMENTS AT CROSSING HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 11, 2017
Last certification
Jul 11, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 7, 1972 in IL
Enrollment address
420 E Central Ave
Decatur, IL 62521-1050

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Comm Health Improv Ctr8 organizations share this tax ID, including this one
Part of
Comm Health Improv Ctr

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Jonathon Matthew Keck Individual Corporate OfficerBoard Member Jul 1, 2022
April L Ingram Individual Corporate OfficerBoard President Jan 1, 2014
Michael R Heneghan Individual Corporate OfficerBoard Treasurer Dec 1, 2009
Tanya R Andricks Individual Corporate OfficerExecutive Director/Ceo Sep 9, 2013
Corporate DirectorExecutive Director/Ceo Sep 9, 2013
W-2 Managing EmployeeExecutive Director/Ceo Sep 9, 2013
Robert T Crawford Individual Corporate OfficerBoard Member Aug 1, 2013

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 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1831635770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E CENTRAL AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214665",
            "telephone_number": "217-877-9117",
            "fax_number": "217-330-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 N WATER ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625231022",
            "telephone_number": "217-330-5676",
            "fax_number": "217-330-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH IMPROVEMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH IMPROVEMENT CENTER",
        "enumeration_date": "2017-01-17",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "ANDRICKS",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "217-877-9117",
        "authorized_official_name_prefix": "Ms."
    },
    "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": "Crossing Healthcare on Water St",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.