CRUSADERS CENTRAL CLINIC ASSOCIATION (NPI# 1265601488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265601488 |
| Entity Type | Organization |
| Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Practice Address |
1100 Broadway Rockford IL 61104-1429 |
| Mailing Address |
1200 W State St Rockford IL 61102-2112 |
| Practice Telephone | 8154901601 |
| Practice Fax Number | 8154901625 |
| Mailing Telephone | 8154901600 |
| Mailing Fax Number | 8154901845 |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2019-03-19 |
| Authorized Official Name | SAMUEL MILLER (CFO) |
| Authorized Official Telephone | 8154901737 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CHAMPUS | 027548 | 01 | |
| BLUE CROSS BLUE SHIELD | 1011514778 | 01 | |
| DORAL | 103436 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205238623 | Crusaders Central Clinic Association | Clinic/Center | 1002 N Pierpont Ave, Rockford, IL 61101 | 2014-09-17 |
| 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 |
| 1073782298 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2008-02-21 |
| Street Address |
1100 BROADWAY |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-1429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952474256 | Catherine Louise Pieper | Pharmacist | 1100 Broadway, Rockford, IL 61104-1429 | 2006-11-16 |
| 1427601855 | Laboratory Corporation of America | Clinical Medical Laboratory | 1100 Broadway, Rockford, IL 61104-1429 | 2019-07-24 |
| 1871023341 | Theresa Marie Sheahan | Nurse Practitioner | 1100 Broadway, Rockford, IL 61104-1429 | 2017-06-15 |
| 1336455773 | Heather Moon Piper | Advanced Practice Midwife | 1100 Broadway, Rockford, IL 61104-1429 | 2010-08-23 |
| 1497953756 | Saleem Wong Siddiqui | Dentist | 1100 Broadway, Rockford, IL 61104-1429 | 2007-07-10 |
| 1215086442 | Crusader Clinic Pharmacy | Pharmacy | 1100 Broadway, Rockford, IL 61104-1429 | 2007-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| 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 |
|---|---|---|---|---|
| 1205238623 | Crusaders Central Clinic Association | Clinic/Center | 1002 N Pierpont Ave, Rockford, IL 61101 | 2014-09-17 |
| 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 |
| 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.