CRUSADER CLINIC BROADWAY
NPI 1265601488
Clinic/Center - Federally Qualified Health Center (FQHC) in Rockford, IL
NPI Status: Active since February 21, 2008
Contact Information
1100 BROADWAY
ROCKFORD, IL
ZIP 61104
Phone: (815) 490-1601
Fax: (815) 490-1625
- Organization
- Clinic/Center
- Federally Qualified Health Center (FQHC)
- Accepts Insurance
- CLIA Number: 14D0925828
- CLIA Cert. Type: Federally Qualified Health Center
- CLIA Exp. Date: 05-31-2027
About CRUSADER CLINIC BROADWAY
This page provides the complete NPI Profile along with additional information for Crusader Clinic Broadway, a primary care provider established in Rockford, Illinois operating as a Clinic/center, focusing in federally qualified health center (fqhc) . The healthcare provider is registered in the NPI registry with number 1265601488 assigned on February 2008. The practitioner's primary taxonomy code is 261QF0400X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's is doing business as Crusader Clinic Broadway. The authorized official of this NPI record is Samuel Miller (President & Ceo)
- NPI
- 1265601488
- Provider Legal Name
- CRUSADERS CENTRAL CLINIC ASSOCIATION
- Other Organization Name
- CRUSADER CLINIC BROADWAY
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1100 BROADWAY ROCKFORD, IL 61104
- Location Phone
- (815) 490-1601
- Location Fax
- (815) 490-1625
- Mailing Address
- 1100 BROADWAY ROCKFORD, IL 61104
- Mailing Phone
- (815) 490-1600
- Mailing Fax
- (815) 490-1625
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 02-21-2008
- Last Update Date
- 08-24-2022
- Code Navigator
A primary care provider (PCP) like Crusader Clinic Broadway sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Federally Qualified Health Center (FQHC)
- Taxonomy Code
- 261QF0400X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Complete Silver - EPO
- Complete Silver + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- MercyCare Bronze 10,000 (1 Free PCP Visit) - HMO
- MercyCare Bronze Standard Expanded - HMO
- MercyCare Gold Standard - HMO
- MercyCare Silver 2,500 (3 Free PCP Visits) - HMO
- MercyCare Silver Health Savings - HMO
- MercyCare Silver Standard - HMO
- Lone Star - Smile Now - PPO
- Smile Now Arizona - No Waiting Period PPO - PPO
- Smile Now Michigan - No Waiting Period PPO - PPO
- Smile Now Ohio - No Waiting Period PPO - PPO
- Smile Now Texas- No Waiting Period Plan - PPO
- Smile Now Utah - No Waiting Period PPO - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 103436 | OTHER (01) | DORAL | |
| 027548 | OTHER (01) | CHAMPUS | |
| 1011514778 | OTHER (01) | BLUE CROSS BLUE SHIELD |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D0925828
- Facility Type
- Federally Qualified Health Center
- Certificate Effective Date
- June 01, 2025
- Certificate Expiration Date
- May 31, 2027
- Laboratory Director
- GARY FERNANDO
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Crusader Clinic Broadway in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1265601488, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 52. The final step is to find the difference between that total and the next multiple of ten (60 - 52 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 52 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 6 providers are registered at the same or a nearby location.
ROCKFORD, IL 61104
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1265601488, enumerated as an "organization" on February 21, 2008.
The provider is located at 1100 BROADWAY ROCKFORD, IL 61104 and the phone number is (815) 490-1601.
Clinic/Center with taxonomy code 261QF0400X and a focus in Federally Qualified Health Center (FQHC).
The provider might be accepting Accepts: Ambetter from Home State Health, Ambetter Health,. Please consult your insurance carrier or call the provider to verify.
