NPIMap

Organization Active NPI

Central Counties Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, IL
National Provider Identifier
1861480709
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL COUNTIES HEALTH CENTERS, INC.
Practice address
2239 E Cook St
Springfield, IL 62703-1944
Phone
(217) 788-2300
Fax
(217) 788-2343
NPI assigned
Oct 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Authorized official

Name
Cindy Kavanagh
Title
Accountant
Phone
(217) 788-2300

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X IL Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2239 E Cook St
Springfield, IL 62703-1944

Mailing address

2239 E Cook St
Springfield, IL 62703-1944
Phone (217) 788-2300

Other names 1

  • Capitol Community Health Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000319 IL Part B Supplier - Clinic/Group Practice 3274445762 Receives reassigned benefits from 19 practitioners
Practice locations: Springfield, IL
O20050106000450 IL Part A Provider - Federally Qualified Health Center (FQHC) 3274445762 Practice locations: Springfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861480709. Details of each certification follow.

Federally qualified health center certification: CCN 141897

Legal name
CENTRAL COUNTIES HEALTH CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2000
Last certification
Jun 7, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1996 in IL
Enrollment address
2239 E Cook St
Springfield, IL 62703-1944

Other NPIs with the same Medicare PAC ID 4

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

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
14D0933419Central Counties Health Centers Inc2239 E Cook St, Springfield, IL 62703Certificate of waiverJan 12, 2028
14D0968767Central Counties Health Centers Inc2239 E Cook St, Springfield, IL 62703Provider-performed microscopyDec 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Cntys HLTH CTRS Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2239 E Cook St
Springfield, IL 62703

1023 E Washington St
Springfield, IL 62703

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Misty Hall Individual Corporate DirectorDirector Dec 17, 2019 7%
David Mytar Individual Corporate Director Dec 17, 2019
Sandra Yard Individual Corporate Director Aug 21, 2017 7%
Julie Ann Janssen Individual Corporate OfficerChairman Nov 12, 2013 9%
Patricia Flores Aguirre Individual Corporate Director Mar 26, 2024
James T Greenwald Individual Corporate DirectorBoard Member Jul 1, 2003 8%
Sam Gaines Individual Corporate DirectorBoard Member Jul 1, 2000 8%
Michael Myles Individual Corporate DirectorBoard Member Jul 1, 2003 8%
Racine Freeman Individual Corporate DirectorBoard Member Jul 1, 2009 7%
Elaina White Individual Corporate Director Mar 26, 2024
Brad Buzzard Individual Corporate OfficerCoo Dec 20, 1999 8%
W-2 Managing EmployeeChief Operating Officer Nov 12, 2013
Angel R Macgibbon Individual Corporate OfficerCfo Jul 27, 2020 8%
W-2 Managing Employee Jul 27, 2020
Judy Henderson Individual Corporate Director Apr 8, 2014 8%
Lois Davis Individual Corporate DirectorDirector Nov 26, 2019 7%
Heather Burton Individual Corporate OfficerChief Executive Officer Jun 30, 2014 8%
W-2 Managing EmployeeChief Executive Officer Jun 30, 2014

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1861480709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2239 E COOK ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031944",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2239 E COOK ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031944",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COUNTIES HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "KAVANAGH",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "217-788-2300"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capitol Community Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.