Access Community Health Network

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

ACCESS COMMUNITY HEALTH NETWORK

Practice address

245 S Gary Ave
Bloomingdale, IL 60108-2228

Phone

(630) 893-5230

NPI assigned

Nov 6, 2006

Last updated

Mar 22, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna Thompson

Title

Ceo

Phone

(312) 526-2051

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881773232. Details of each certification follow.

• CCN 141971 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 141971

Legal name

ACCESS COMMUNITY HEALTH NETWORK

Doing business as

MARTIN RUSSO FAMILY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 2, 2004

Last certification

Feb 2, 2004

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 11, 1984 in IL

Enrollment address

245 S Gary Ave
Lowr Level
Bloomingdale, IL 60108-2228

Related CCNs

141927

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1629156807

  Related provider number

  Provider of Services

Locations

All disclosed owners & managing parties 16

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

Practitioners 18

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.

• Amela I Dedic, PA-C

  • Physician Assistant
  • Bloomingdale, IL
  • NPI 1154198133
  NPD
• Joy Deleoz, MD

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1083697171
  NPD
• Tally Lynn Hollin, A.P.N.

  • Family Nurse Practitioner
  • Winfield, IL
  • NPI 1518251149
  NPD
• Tara Kristiansen, APRN

  • Family Nurse Practitioner
  • Sycamore, IL
  • NPI 1902539463
  NPD
• Kenneth Michael Kwiatkowski

  • Pediatrics Physician
  • Naperville, IL
  • NPI 1538179361
  NPD
• Nicole Marie Locascio, PA-C

  • Physician Assistant
  • Libertyville, IL
  • NPI 1366073645
  NPD
• Greta Obereiner, APN

  • Pediatric Nurse Practitioner
  • Champaign, IL
  • NPI 1053599423
  NPD
• Preyanshu M Parekh, DO

  • Family Medicine Physician
  • Libertyville, IL
  • NPI 1063864734
  NPD
• Viviana Rivera, FNP

  • Family Nurse Practitioner
  • Elgin, IL
  • NPI 1841748167
  NPD
• Camila Salvador, PA-C

  • Physician Assistant
  • Glenview, IL
  • NPI 1235729484
  NPD
• William Sandoval, MD

  • Family Medicine Physician
  • Belvidere, IL
  • NPI 1912080912
  NPD
• Uzma Shamsi, MS, FNP-C

  • Nurse Practitioner
  • Westmont, IL
  • NPI 1003334418
  NPD

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1881773232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W FULTON",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606611262",
            "telephone_number": "312-526-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S GARY AVE",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601082228",
            "telephone_number": "630-893-5230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-526-2051"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Adamowski
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• Federally Qualified Health Center (FQHC) in Bloomingdale, IL
• Providers in Bloomingdale, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.