NPIMap

Organization Active NPI

Access Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Bloomingdale, IL
National Provider Identifier
1881773232
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
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
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

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

Addresses

Primary practice location

245 S Gary Ave
Bloomingdale, IL 60108-2228

Mailing address

600 W Fulton
Suite 200
Chicago, IL 60661-1262
Phone (312) 526-2551

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20031223000393 IL Part A Provider - Federally Qualified Health Center (FQHC) 9537076112 Practice locations: Bloomingdale, IL

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

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

National Provider Directory

National Provider Directory

Locations

245 S Gary Ave
#T
Bloomingdale, IL 60108
Phone (630) 893-5230

245 S Gary Ave
Bloomingdale, IL 60108
Phone (630) 305-6301

Ownership & related parties

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.

NameRoleSinceShare
Perla Herrera Individual Corporate DirectorBoard Member Sep 1, 2013
Thomas P Fitzgibbon Individual Corporate DirectorBoard Member Mar 1, 2013
Virginia Oviedo Individual Corporate DirectorBoard Member Apr 1, 2011
Julio Morejon Individual Corporate DirectorBoard Member Jul 1, 2019
Denise Kitchen Individual Corporate DirectorBoard Member Jun 1, 2007
Patricia Bobb Individual Corporate DirectorBoard Member Jul 10, 2010
Nicole Jackson Individual Corporate DirectorAuthorized Official Sep 9, 2024
W-2 Managing EmployeeAuthorized Official Sep 9, 2024
Dakisha Mitchell Individual Corporate DirectorBoard Member Mar 1, 2021
Donna Simmons Individual Corporate DirectorBoard Member Mar 1, 2000
Peter McNerney Individual Corporate DirectorBoard Member Feb 1, 2015
Maria Jennifer J Zepeda Individual Corporate DirectorBoard Member Jan 1, 2022
Elizabeth Perez Individual Corporate DirectorBoard Member Sep 1, 2017
Matthew Berkley Individual Corporate DirectorBoard Member Jun 1, 2018
Kim L Ellen Individual Corporate DirectorBoard Member Oct 1, 2019
Ryan Hart Individual Corporate DirectorBoard Member Mar 1, 2013
Sharon Gibson Individual Corporate DirectorBoard Member Jan 1, 2018

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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": []
}

Other providers in Bloomingdale, IL

Sources for this page

Verify at the official NPI Registry.