NPIMap

Organization Active NPI

Primecare Community Health Inc

Doing business as Elston

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1891541215
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMECARE COMMUNITY HEALTH INC
Doing business as
Elston
Practice address
1308 N Elston Ave
Chicago, IL 60642-2416
Phone
(312) 633-5841
NPI assigned
Apr 26, 2024
Last updated
Apr 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Authorized official

Name
Michael C Holtrop
Title
Cfo
Phone
(616) 482-9892

Specialties & licenses 1

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

Addresses

Primary practice location

1308 N Elston Ave
Chicago, IL 60642-2416

Mailing address

1431 N Western Ave Ste 406
Chicago, IL 60622-1774
Phone (312) 633-5841

Other names 1

  • Elston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240712002570 IL Part A Provider - Federally Qualified Health Center (FQHC) 6204722077 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891541215. Details of each certification follow.

Federally qualified health center certification: CCN C41028

Legal name
PRIMECARE COMMUNITY HEALTH, INC.
Doing business as
ELSTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 24, 2024
Last certification
Jun 24, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1992 in IL
Enrollment address
1308 N Elston Ave
Chicago, IL 60642-2416

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Elston3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

4235 W North Ave
Chicago, IL 60639
Phone (773) 276-3360

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Luis Vidal Individual Corporate DirectorBoard Member Jan 1, 2024
Michael H Friedman Individual Corporate DirectorBoard Member Jan 1, 2024
Latonda Davenport Individual Corporate DirectorBoard Member Jan 1, 2024
Jean Schwab Individual Corporate DirectorBoard Member Jan 1, 2024
Lynn Hopkins Individual Corporate OfficerCeo May 1, 2024 50%
Jose Silva Individual Corporate DirectorBoard Member Jan 1, 2024
Sonia Talavera Individual Corporate DirectorBoard Member Jan 1, 2024
Shawna Lecuyer Individual Corporate DirectorBoard Member Jan 1, 2024
Randall Palmer Individual Corporate DirectorBoard Member Jan 1, 2024
Rosita de la Rosa Individual Corporate DirectorBoard Member Jan 1, 2024
Cheryl Reese Individual Corporate DirectorBoard Member Jan 1, 2024
Marie Pagan Individual Corporate DirectorBoard Member Jan 1, 2024
Luis Reyes Individual Corporate DirectorBoard Member Jan 1, 2024
Perpetua Ruiz Individual Corporate DirectorBoard Member Jan 1, 2024
Michael Holtrop Individual Corporate Officer May 1, 2024 50%
W-2 Managing EmployeeCFW May 1, 2024 50%
Victoria Levin Sniegowski Individual Corporate DirectorBoard Member Jan 1, 2024
Robert J Cech Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 92

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 92

NPI Registry JSON

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

{
    "created_epoch": "1714089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1891541215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 N WESTERN AVE STE 406",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221774",
            "telephone_number": "312-633-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422416",
            "telephone_number": "312-633-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-26",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "HOLTROP",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-482-9892"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.