NPIMap

Organization Active NPI

Macoupin County Public Health Department

Doing business as Columbian Boulevard Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Litchfield, IL
National Provider Identifier
1831798958
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Doing business as
Columbian Boulevard Dental Clinic
Practice address
125 W Columbian Blvd S
Litchfield, IL 62056-3021
Phone
(217) 854-3223
NPI assigned
Oct 20, 2020
Last updated
Mar 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Christy Blank
Title
Ceo
Phone
(217) 930-2283

Specialties & licenses 1

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

Addresses

Primary practice location

125 W Columbian Blvd S
Litchfield, IL 62056-3021

Mailing address

205 Oakland Ave
Carlinville, IL 62626-1921
Phone (217) 839-7820

Other names 1

  • Columbian Boulevard Dental Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060223000446 IL Part B Supplier - Clinic/Group Practice 1557377850 Receives reassigned benefits from 21 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carlinville, IL; Gillespie, IL; Litchfield, IL
O20201229001853 IL Part A Provider - Federally Qualified Health Center (FQHC) 1557377850 Practice locations: Litchfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831798958. Details of each certification follow.

Federally qualified health center certification: CCN 781947

Legal name
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Doing business as
COLUMBIAN BOULEVARD DENTAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2020
Last certification
Nov 1, 2020
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Oct 20, 2010 in IL
Enrollment address
125 W Columbian Blvd S
Litchfield, IL 62056-3021

Other NPIs with the same Medicare PAC ID 5

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
14D2202506Macoupin County Public Health Department125 W Columbian Blvd S, Litchfield, IL 62056Provider-performed microscopyNov 28, 2026

National Provider Directory

National Provider Directory
Tax ID family
Macoupin County Health Dept8 organizations share this tax ID, including this one

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 4

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

NameRoleSinceShare
Christy Blank Individual Corporate DirectorCeo Mar 5, 2018
W-2 Managing Employee Mar 5, 2018
Lori Sanson Individual Corporate OfficerCfo Sep 4, 2001
W-2 Managing Employee Sep 4, 2001
Thomas E Hatley Individual Corporate OfficerVice Precident Nov 8, 2024
Michael Levora Individual Corporate OfficerPresident Nov 8, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Macoupin County Public Health DepartmentGillespie, IL, CCN 141154 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 20, 2010
Macoupin County Public Health DepartmentCarlinville, IL, CCN 781864 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 21, 2012
Macoupin County Public Health DepartmentCarlinville, IL, CCN 141824 Federally qualified health center Operational/Managerial Control Sep 1, 2014

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1831798958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 OAKLAND AVE",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261921",
            "telephone_number": "217-839-7820",
            "fax_number": "217-839-1538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W COLUMBIAN BLVD S",
            "city": "LITCHFIELD",
            "state": "IL",
            "postal_code": "620563021",
            "telephone_number": "217-854-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-930-2283"
    },
    "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": "Columbian Boulevard Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbian Boulevard Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Litchfield, IL

Sources for this page

Verify at the official NPI Registry.