NPIMap

Organization Active NPI

Will County Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Joliet, IL
National Provider Identifier
1902811714
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WILL COUNTY COMMUNITY HEALTH CENTER
Practice address
1106 Neal Ave
Joliet, IL 60433-2548
Phone
(815) 727-8670
Fax
(815) 727-8852
NPI assigned
Jul 30, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WILL COUNTY HEALTH DEPTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Susan Olenek
Title
Executive Director
Phone
(815) 740-8982

Specialties & licenses 1

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

Addresses

Primary practice location

1106 Neal Ave
Joliet, IL 60433-2548

Mailing address

1106 Neal Ave
Joliet, IL 60433-2548
Phone (815) 727-8670

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000197 IL Part B Supplier - Clinic/Group Practice 5395633317 Receives reassigned benefits from 32 practitioners
2 other NPIs on this enrollment
Practice locations: Bolingbrook, IL; Joliet, IL; Monee, IL
O20060915000561 IL Part A Provider - Federally Qualified Health Center (FQHC) 5395633317 Practice locations: Joliet, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902811714. Details of each certification follow.

Federally qualified health center certification: CCN 141909

Legal name
WILL COUNTY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 14, 2000
Last certification
Jul 14, 2000
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jun 24, 1994 in IL
Enrollment address
1106 Neal Ave
Joliet, IL 60433-2548

Other NPIs with the same Medicare PAC ID 2

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
Part of
Will County Health Department

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Elizabeth Bilotta Individual W-2 Managing Employee Feb 4, 2023
Denise Bergin Individual W-2 Managing EmployeeDirector of Finance and Grants MGMT Dec 1, 2018
County of Will Organization, Joliet, IL 5% Or Greater Direct Ownership Interest Apr 1, 2015 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Will County Community Health Center EastMonee, IL, CCN 781925 Federally qualified health center Operational/Managerial Control (100%) May 6, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1902811714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 NEAL AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604332548",
            "telephone_number": "815-727-8670",
            "fax_number": "815-727-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 NEAL AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604332548",
            "telephone_number": "815-727-8670",
            "fax_number": "815-727-8852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILL COUNTY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILL COUNTY HEALTH DEPT",
        "enumeration_date": "2006-07-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OLENEK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-740-8982"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.