NPIMap

Organization Active NPI

Heartland Alliance Health

Doing business as Heartland Health Outreach - Englewood

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1851828198
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEARTLAND ALLIANCE HEALTH
Doing business as
Heartland Health Outreach - Englewood
Practice address
5501 S Halsted St
Chicago, IL 60621-2229
Phone
(773) 275-2586
NPI assigned
May 17, 2017
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
Edward Stellon, MS
Title
Executive Director
Phone
(312) 405-0802

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X IL
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

5501 S Halsted St
Chicago, IL 60621-2229

Mailing address

4750 N Sheridan Rd Ste 435
Chicago, IL 60640-5078
Phone (773) 751-4129

Other names 2

  • Heartland Health Outreach - Englewood Doing business as
  • Heartland Health Outreach, Inc. Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000481 IL Part B Supplier - Clinic/Group Practice 5890696686 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20180319001144 IL Part A Provider - Federally Qualified Health Center (FQHC) 5890696686 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851828198. Details of each certification follow.

Federally qualified health center certification: CCN 781901

Legal name
HEARTLAND ALLIANCE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 27, 2018
Last certification
Mar 27, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1987 in IL
Enrollment address
5501 S Halsted St
Chicago, IL 60621-2229

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Chicago Health Outreach14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

1015 W Lawrence Ave
Fl 2
Chicago, IL 60640
Phone (773) 275-2586

932 W Washington Blvd
Ste 224
Chicago, IL 60607
Phone (312) 850-0840

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
Alexander Blair Individual Corporate OfficerBoard Member Jan 22, 2020
Corporate DirectorBoard Member Jan 22, 2020
Elissa J Bassler Individual Corporate Director Jan 1, 2024
Rhyan Zweifler Individual Corporate DirectorDirector Jan 25, 2016
Jimmy Valentin Individual Corporate OfficerDirector, Health Information Sytem May 8, 2000
Corporate DirectorDirector, Health Information Sytem May 8, 2000
W-2 Managing EmployeeDirector, Health Information Sys May 8, 2000
Operational/Managerial ControlDirector, Health Information Sys May 8, 2000
Munzoor E Shaikh Individual Corporate DirectorDirector May 20, 2013

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1851828198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 N SHERIDAN RD STE 435",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405078",
            "telephone_number": "773-751-4129",
            "fax_number": "773-751-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 S HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212229",
            "telephone_number": "773-275-2586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND ALLIANCE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-17",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "STELLON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "312-405-0802",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Outreach - Englewood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heartland Health Outreach, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.