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CRUSADER CLINIC BROADWAY
NPI 1265601488
Clinic/Center - Federally Qualified Health Center (FQHC) in Rockford, IL

Active since February 21, 2008CLIA Certified · 2 labs
1100 BROADWAY, ROCKFORD, IL 61104(815) 490-1601(815) 490-1625 Get Directions Write a Review

NPPES record last updated: August 24, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 24, 2022, Feb 25, 2022, Mar 19, 2019 (3 updates tracked since 2019).

About Crusader Clinic Broadway NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRUSADER CLINIC BROADWAY (NPI 1265601488) is a healthcare organization registered as a federally qualified health center (fqhc) in Rockford, Illinois and active in the NPI registry since February 2008. The organization holds 2 active CLIA laboratory certificates and lists Samuel Miller, President & Ceo, as its authorized official.

NPPES Registry Identity

NPI1265601488
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameCRUSADERS CENTRAL CLINIC ASSOCIATION
Location Address1100 BROADWAYRockford, IL 61104-1429
Mailing Address1100 BroadwayRockford, IL 61104-1429 · (815) 490-1600 · Fax (815) 490-1845
Phone(815) 490-1601
Fax(815) 490-1625
Organization SubpartYes
Authorized OfficialSamuel MillerPresident & Ceo · (815) 490-1737
Enumeration DateFebruary 21, 2008
Last NPPES UpdateAugust 24, 20223 updates tracked since enumeration
NPPES CertifiedAugust 24, 2022
✔ NPI 1265601488 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
1100 BROADWAY, Rockford, IL 61104
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Other Names 1

Doing Business AsCrusader Clinic Broadway

Other Identifiers 3

Other103436Doral
Other027548Champus
Other1011514778Blue Cross Blue Shield

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D0663432

Crusaders Clinic Broadway · Rockford, IL
Active · expires May 31, 2027
CLIA Number14D0663432
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJune 1, 2025
Certificate Expiration DateMay 31, 2027
Laboratory DirectorGary Fernando
Laboratory Phone(815) 490-1600
Laboratory LocationCrusaders Clinic Broadway1100 Broadway, Rockford, IL 61104
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D0925828

Crusader Clinic · Rockford, IL
Active · expires May 31, 2027
CLIA Number14D0925828
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJune 1, 2025
Certificate Expiration DateMay 31, 2027
Laboratory DirectorGary Fernando
Laboratory Phone(815) 490-1600
Laboratory LocationCrusader Clinic1200 W State Street, Rockford, IL 61102
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. HEATHER MOON PIPER R.N., M.S., C.N.M.
Advanced Practice Midwife
1100 BROADWAY
ROCKFORD, IL 61104
Winnebago County (815) 490-1600
LABORATORY CORPORATION OF AMERICA
Clinical Medical Laboratory
1100 BROADWAY
ROCKFORD, IL 61104
Winnebago County (815) 516-0038
MISS AMANDA CATHERINE FRASER PA-C
Physician Assistant
1100 BROADWAY
ROCKFORD, IL 61104
Winnebago County (815) 490-1600
CRUSADERS CENTRAL CLINIC ASSOCIATION
Health Educator
1100 BROADWAY
ROCKFORD, IL 61104
Winnebago County (815) 490-1600
MRS. THERESA MARIE SHEAHAN NP
Nurse Practitioner (Family)
1100 BROADWAY
ROCKFORD, IL 61104
Winnebago County (815) 490-1600
CATHERINE LOUISE PIEPER PHARMACIST
Pharmacist
1100 BROADWAY
ROCKFORD, IL 61104
Winnebago County (815) 490-1354

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crusaders Central Clinic Association's NPI number?

The NPI number for Crusaders Central Clinic Association is 1265601488. It was assigned to this organization in the NPPES registry on February 21, 2008. The provider is doing business as Crusader Clinic Broadway.

Where is Crusaders Central Clinic Association located?

Crusaders Central Clinic Association is located at 1100 Broadway, Rockford, IL 61104. The listed phone number is (815) 490-1601.

What is Crusaders Central Clinic Association's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Crusaders Central Clinic Association hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Crusaders Central Clinic Association accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, MercyCare Health Plans and UnitedHealthcare list Crusaders Central Clinic Association as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Crusaders Central Clinic Association was last updated on August 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.