NPIMap

Organization Active NPI

Friend Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1891921623
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FRIEND FAMILY HEALTH CENTER INC
Practice address
4802 S Ashland Ave
Chicago, IL 60609-4233
Phone
(773) 376-9400
NPI assigned
Jun 8, 2009
Last updated
Aug 6, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
FRIEND FAMILY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

Name
Angel McReynolds
Title
Billing/Provider Services MGR
Phone
(773) 705-2260

Specialties & licenses 1

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

Addresses

Primary practice location

4802 S Ashland Ave
Chicago, IL 60609-4233

Mailing address

2436 W 47TH St
Chicago, IL 60632-1336

Other identifiers 1

IdentifierTypeStateIssuer
141163OtherILMEDICARE PTAN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040805001242 IL Part B Supplier - Clinic/Group Practice 2062494552 Receives reassigned benefits from 129 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20120710000325 IL Part A Provider - Federally Qualified Health Center (FQHC) 2062494552 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891921623. Details of each certification follow.

Federally qualified health center certification: CCN 141163

Legal name
FRIEND FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 10, 2012
Last certification
Aug 10, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1997 in IL
Enrollment address
4802 S Ashland Ave
Chicago, IL 60609-4233

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Friend Family Health Center- Beethoven9 organizations share this tax ID, including this one
Part of
Friend Family Health Center- Beethoven

Other organizations with this tax ID 8

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

Locations

2436 W 47th St
Chicago, IL 60632

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Arshele Stevens Individual Corporate DirectorBoard Member Aug 23, 2024
Sean Harden Individual Corporate DirectorBoard Member Apr 1, 2006
Wendy Thompson Individual Corporate DirectorCeo Jun 30, 2024
W-2 Managing Employee Jun 30, 2024
Carlos Meyers Individual Corporate DirectorVice Chair Aug 23, 2024
Joanne Glenn Individual Corporate DirectorExecutive Board Member Aug 23, 2024
Maria McManus Individual Corporate DirectorSecretary Aug 23, 2024
Ethel Hall-Langworthy Individual Corporate DirectorBoard Member Apr 1, 2005
Raheel Shahzad Individual Corporate OfficerCfo Aug 23, 2024
W-2 Managing EmployeeCfo Aug 23, 2024
Operational/Managerial ControlCfo Aug 23, 2024

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1891921623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2436 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606321336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 S ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606094233",
            "telephone_number": "773-376-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIEND FAMILY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRIEND FAMILY HEALTH CENTER",
        "enumeration_date": "2009-06-08",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "MCREYNOLDS",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "BILLING/PROVIDER SERVICES MGR",
        "authorized_official_telephone_number": "773-705-2260"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "141163",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.