NPIMap

Organization Active NPI

Solvera Healthcare Center Inc

  • Federally Qualified Health Center (FQHC)
  • Peoria, IL
National Provider Identifier
1881442770
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOLVERA HEALTHCARE CENTER INC
Practice address
3525 N University St
Peoria, IL 61604-1324
Phone
(309) 886-9172
NPI assigned
May 7, 2024
Organization subpart
Yes
Parent organization
SOLVERA HEALTHCARE CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
Patrick Caplis
Title
Ceo
Phone
(309) 886-9172

Specialties & licenses 1

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

Addresses

Primary practice location

3525 N University St
Peoria, IL 61604-1324

Mailing address

PO Box 9727
Peoria, IL 61612-9727
Phone (309) 886-9172

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210806002385 IL Part B Supplier - Clinic/Group Practice 4981007226 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carbondale, IL; Peoria, IL
O20240617000098 IL Part A Provider - Federally Qualified Health Center (FQHC) 4981007226 Practice locations: Peoria, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881442770. Details of each certification follow.

Federally qualified health center certification: CCN C41023

Legal name
SOLVERA HEALTHCARE CENTER INC
Doing business as
SOLVERA HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 30, 2024
Last certification
Apr 30, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 2021 in IL
Enrollment address
3525 N University St
Peoria, IL 61604-1324

Other NPIs with the same Medicare PAC ID 3

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
Solvera Healthcare Center3 organizations share this tax ID, including this one
Part of
Solvera Healthcare Center

Other organizations with this tax ID 2

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

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
Daniel Kerns Individual Corporate DirectorBoard Member Sep 1, 2022
Douglas Shaw Individual Corporate DirectorBoard Member Mar 22, 2021
Sarai Marchan Individual Corporate DirectorBoard Member Mar 22, 2021
Chukwuka a Chidi Individual Corporate OfficerChief Financial Officer Dec 1, 2023
Robin Henry Individual Corporate OfficerChief Operating Officer Dec 3, 2023
Patrick Caplis Individual Corporate OfficerChief Executive Officer Aug 1, 2021
W-2 Managing EmployeeChief Executive Officer Aug 1, 2021
Michael Miller Individual Corporate DirectorBoard Member Mar 22, 2021
Mary Weyeneth Individual Corporate DirectorBoard Member Jul 1, 2021
Solvera Healthcare Center Inc Organization, Peoria, IL Corporation, Non-profit Other Mar 22, 2021 100%
Alison Millinger Individual Corporate DirectorBoard Member Sep 1, 2021
Alexander Shaw Individual Corporate DirectorBoard Member Aug 1, 2022
Jerry Mitchell Individual Corporate DirectorBoard Member Apr 1, 2023
Zahida Mughal Individual Corporate OfficerChief Medical Officer Jan 1, 2024
Jeffrey Gengenbach Individual Corporate DirectorBoard Member Oct 1, 2023
Ann Johnston-Rae Individual Corporate DirectorBoard Member Jun 21, 2022

Owners & managing parties with NPI records 4

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1881442770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9727",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616129727",
            "telephone_number": "309-886-9172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616041324",
            "telephone_number": "309-886-9172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLVERA HEALTHCARE CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOLVERA HEALTHCARE CENTER INC",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "CAPLIS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-886-9172"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.