CRUSADERS CENTRAL CLINIC ASSOCIATION (NPI# 1417203191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417203191 |
| Entity Type | Organization |
| Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Other Organization Name | CRUSADER COMMUNITY HEALTH |
| Practice 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 | 2012-07-31 |
| Last Update Date | 2019-03-19 |
| Authorized Official Name | MR. GORDON EGGERS (PRESIDENT AND CEO) |
| Authorized Official Telephone | 8154901600 |
| Authorized Official Credential | PA |
| 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 | Doing Business As Name - Organization |
| 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 |
| 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 |
1200 W STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61102-2112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780680827 | Barbara B Morgan | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2005-06-23 |
| 1588271894 | Angela Siebold | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2020-09-30 |
| 1942814322 | Jacqueline Paige Cabrera | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2020-09-03 |
| 1285250951 | Aaleeyah Pringle Alim | Dentist | 1200 W State St, Rockford, IL 61102-2112 | 2020-06-18 |
| 1639792419 | Jessica Lauren Cole | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2020-05-27 |
| 1437779071 | Christian Murillo | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2020-04-23 |
| 1033746573 | Erin Ashleigh Donahue | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2020-03-25 |
| 1609406008 | Marissa Dreger | Family Medicine | 1200 W State St, Rockford, IL 61102-2112 | 2020-01-24 |
| 1962041657 | Sabrina Lee Puvalowski | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2019-12-30 |
| 1932741717 | Jacob Dalton Boehm | Physician Assistant | 1200 W State St, Rockford, IL 61102-2112 | 2019-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205115383 | Renee Lynn Keeney | Advanced Practice Midwife | 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 | 2011-08-08 |
| 1689895906 | Linda Lou O'reilly | Local Education Agency (LEA) | 1515 S. Meridian Road, Rockford, IL 61102 | 2007-05-02 |
| 1801012992 | Jennifer Anne Boyd | Developmental Therapist | Nia 1515 S. Meridian Rd., Rockford, IL 61102 | 2007-04-17 |
| 1609173434 | Kellie J Gibbons | Registered Nurse | 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 | 2011-02-14 |
| 1275708752 | Mercy Ambulance Service LLC | Ambulance | 1025 Campton Dr, Rockford, IL 61102-1066 | 2008-04-25 |
| 1417448424 | Brittany Nicole Lambert | Student in an Organized Health Care Education/Training Program | 8040 Towermont Dr, Rockford, IL 61102-1080 | 2018-05-24 |
| 1164490132 | Harlan Johnson | Counselor | 852 Lakewood Dr, Rockford, IL 61102-1228 | 2006-03-08 |
| 1184137283 | Gail Mary Swenson | Speech-Language Pathologist | 730 Lincoln Park Blvd, Rockford, IL 61102-1429 | 2017-11-10 |
| 1659316339 | Institute of Family Care | Home Health | 417 S Pierpont Ave, Rockford, IL 61102-1656 | 2006-06-18 |
| 1861851438 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1200 W State St Ste 102, Rockford, IL 61102-2112 | 2016-02-11 |
| Find all providers in zip 61102 | ||||
| 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 |
| 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.