Access Community Health Network
Organization Active NPI Federally Qualified Health Center (FQHC) · Summit, IL
NPI 1871671990 · NPPES record last updated Mar 22, 2017
Key facts
- NPI
- 1871671990
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ACCESS COMMUNITY HEALTH NETWORK
- Practice address
- 7450 W 63Rd St
Summit, IL 60501-1816 - Phone
- (708) 458-0757
- NPI assigned
- Nov 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Donna Thompson
- Title
- Ceo
- Phone
- (312) 526-2051
Corporate family (same tax ID) 28
Practitioners 7
-
Georgina Cano, MSW
-
Maribel Corral, PA-C
-
Giulia Mobarhan, M.D.
-
Alok Rastogi, M.D.
-
Suwan Mehra, MD
-
Rachel Unger, PHYSICIAN ASSISTANT
-
Raja Kumari Vaidadi, M.D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Federally qualified health center certification: CCN 141916
- Legal name
- ACCESS COMMUNITY HEALTH NETWORK
- Doing business as
- DES PLAINES VALLEY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 3, 2001
- Last certification
- Apr 3, 2001
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 11, 1984 in IL
- Enrollment address
- 7450W 63Rd St
Summit, IL 60501-1816
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Perla Herrera |
Corporate Director | Sep 1, 2013 | |
| Donna Thompson |
Corporate Officer |
Jul 1, 1995 | 100% |
| W-2 Managing Employee |
Jul 1, 1995 | 100% | |
| Thomas P Fitzgibbon |
Corporate Director | Mar 1, 2013 | |
| Virginia Oviedo |
Corporate Director | Apr 1, 2011 | |
| Julio Morejon |
Corporate Director | Sep 1, 2017 | |
| Denise Kitchen |
Corporate Director | Jun 1, 2007 | |
| Patricia Bobb |
Corporate Director | Jul 10, 2010 | |
| Donna Simmons |
Corporate Director | Mar 1, 2000 | |
| Peter McNerney |
Corporate Director | Feb 1, 2015 | |
| Terry Brown |
Corporate Director | Mar 1, 2000 | |
| Elizabeth Perez |
Corporate Director | Sep 1, 2017 | |
| Matthew Berkley |
Corporate Director | Jun 1, 2018 | |
| Lilia Gonzalez |
Corporate Director | Jan 1, 2018 | |
| Miriam Mobley-Smith |
Corporate Director | Sep 1, 2017 | |
| Erin Starkey |
Corporate Director | Jul 1, 2010 | |
| Ryan Hart |
Corporate Director | Mar 1, 2013 | |
| Sharon Gibson |
Corporate Director | Jan 1, 2018 | |
| Charles Deshazer |
Corporate Director | Apr 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031204000985 | IL | Part B Supplier - Clinic/Group Practice | 9537076112 |
Receives reassigned benefits from 512 practitioners This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL; Chicago Heights, IL; Cicero, IL; Des Plaines, IL; Evanston, IL; Heights, IL; Melrose Park, IL; Summit, IL… |
| O20040213000228 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 9537076112 | Practice locations: Summit, IL |
National Provider Directory
- Tax ID family
- Access Community Health
Locations
1817 S Loomis St
Chicago, IL 60608
Phone (312) 666-6511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
7450 W 63Rd St
Summit, IL 60501-1816
Mailing address
600 W Fulton
Suite 200
Chicago, IL 60661-1262
Phone (312) 526-2051
Other providers in Summit, IL
- Gina Aalders
- Advanced Podiatry
- Argo Comm HS Dist 217
- Katie Lynn Banker
- Katarzyna Ceglinski
- Yuritzy Chavez
All providers in Summit, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.