CRUSADERS CENTRAL CLINIC ASSOCIATION (NPI# 1205238623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205238623 |
| Entity Type | Organization |
| Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Other Organization Name | CRUSADER COMMUNITY HEALTH AUBURN CAMPUS |
| Practice Address |
1002 N Pierpont Ave Rockford IL 61101 |
| Mailing Address |
1200 W State St Rockford IL 61102-2112 |
| Practice Telephone | 8154901600 |
| Practice Fax Number | 8154901625 |
| Mailing Telephone | 8154901600 |
| Mailing Fax Number | 8154901845 |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2019-03-19 |
| Authorized Official Name | GORDON EGGERS (CEO) |
| Authorized Official Telephone | 8154901600 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | Y |
| Parent Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Crusader Community Health Auburn Campus | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891082194 | Crusaders Central Clinic Association | Clinic/Center | 6115 N 2nd St, Loves Park, IL 61111-4155 | 2011-07-07 |
| 1780852244 | Crusaders Central Clinic Association | Clinic/Center | 1050 Logan Ave, Belvidere, IL 61008-3966 | 2008-02-18 |
| 1164999892 | Crusaders Central Clinic Association | Case Management | 1200 W State St, Rockford, IL 61102-2112 | 2018-10-31 |
| 1346762390 | Crusaders Central Clinic Association | Clinic/Center | 840 Blackhawk Blvd, South Beloit, IL 61080-2263 | 2017-07-12 |
| 1811419245 | Crusaders Central Clinic Association | Clinic/Center | 245 Prairie Hill Rd, South Beloit, IL 61080-2579 | 2017-07-07 |
| 1508306861 | Crusaders Central Clinic Association | Clinic/Center | 1215 N Alpine Rd, Rockford, IL 61107-2201 | 2017-03-06 |
| 1922358373 | Crusaders Central Clinic Association | Clinic/Center | 2704 N Main St, Rockford, IL 61103-3112 | 2012-09-13 |
| 1417203191 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2012-07-31 |
| 1265601488 | Crusaders Central Clinic Association | Clinic/Center | 1100 Broadway, Rockford, IL 61104-1429 | 2008-02-21 |
| 1073782298 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2008-02-21 |
| Street Address |
1002 N PIERPONT AVE |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417338799 | Latavia Shantaye Agada | Social Worker | 2823 Glenwood Ave., Rockford, IL 61101 | 2015-06-12 |
| 1013397561 | Charlene Donahoe | Student in an Organized Health Care Education/Training Program | 235 Wyman St, Rockford, IL 61101 | 2015-05-30 |
| 1780717454 | Hearing Pros Inc | Audiologist | 3902 West Riverside Blvd, In Wal Mart, Rockford, IL 61101 | 2007-03-13 |
| 1821156951 | Neurological Clinic of Rockford Sc | Neurological Surgery | 2825 Glenwood Avenue, Rockford, IL 61101 | 2006-12-04 |
| 1265470496 | Daniel Sommer | Social Worker | 2823 Glenwood Avenue, Rockford, IL 61101 | 2006-06-02 |
| 1508093253 | Patricia Kroll | Social Worker | 526 W State Street, Rockford, IL 61101 | 2009-06-19 |
| 1346462330 | Carol J O'haron | Social Worker | 526 W State Street, Rockford, IL 61101 | 2007-05-02 |
| 1356563332 | Lynn E Cadmus | Social Worker | 526 W State Street, Rockford, IL 61101 | 2007-05-02 |
| 1083836928 | Carol L Craig | Psychiatry & Neurology | 526 W State Street, Rockford, IL 61101 | 2007-05-02 |
| 1578785432 | Richard L Jaconette | Psychiatry & Neurology | 526 W State Street, Rockford, IL 61101 | 2007-05-02 |
| Find all providers in zip 61101 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306486022 | The Board of Trustees of The University of Illinois | Clinic/Center | 1221 E State St, Rockford, IL 61104-2231 | 2020-01-10 |
| 1295386308 | Altapointe Health Systems, Inc. | Clinic/Center | 9518 Us Highway 231, Rockford, AL 35136-5214 | 2019-09-20 |
| 1043746720 | Aunt Martha's Health and Wellness | Clinic/Center | 1401 E State St, Suite 3000, Rockford, IL 61104-2315 | 2017-05-02 |
| 1508306861 | Crusaders Central Clinic Association | Clinic/Center | 1215 N Alpine Rd, Rockford, IL 61107-2201 | 2017-03-06 |
| 1922358373 | Crusaders Central Clinic Association | Clinic/Center | 2704 N Main St, Rockford, IL 61103-3112 | 2012-09-13 |
| 1417203191 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2012-07-31 |
| 1265601488 | Crusaders Central Clinic Association | Clinic/Center | 1100 Broadway, Rockford, IL 61104-1429 | 2008-02-21 |
| 1073782298 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2008-02-21 |
| 1437328655 | Crusaders Central Clinic Association | Clinic/Center | 1720 18th Ave, Rockford, IL 61104-7352 | 2008-02-21 |
| 1902972557 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2006-11-27 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.