NPIMap

Organization Active NPI

Perry County Counseling Center Inc

Doing business as Southern Illinois Behavioral Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Du Quoin, IL
National Provider Identifier
1063460897
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PERRY COUNTY COUNSELING CENTER INC
Doing business as
Southern Illinois Behavioral Services
Practice address
1016 S Madison St
Suite a
Du Quoin, IL 62832-2442
Phone
(618) 542-4357
Fax
(618) 542-3442
NPI assigned
May 4, 2006
Last updated
Mar 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John R Venskus
Title
Executive Director
Phone
(618) 542-4357

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Family Nurse Practitioner 363LF0000X NU
Professional Counselor 101YP2500X NU
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

1016 S Madison St
Suite a
Du Quoin, IL 62832-2442

Mailing address

1016 S Madison St
Suite a
Du Quoin, IL 62832-2442
Phone (618) 542-4357

Other names 1

  • Southern Illinois Behavioral Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rhonda.bigham@sibs-pccc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427001264 IL Part B Supplier - Clinic/Group Practice 5092702597 Receives reassigned benefits from 5 practitioners
3 other NPIs on this enrollment
Practice locations: Du Quoin, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Perry County Counseling Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1063460897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 S MADISON ST",
            "address_2": "SUITE A",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628322442",
            "telephone_number": "618-542-4357",
            "fax_number": "618-542-3442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 S MADISON ST",
            "address_2": "SUITE A",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628322442",
            "telephone_number": "618-542-4357",
            "fax_number": "618-542-3442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "VENSKUS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-542-4357"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rhonda.bigham@sibs-pccc.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1016 S Madison St",
            "address_2": "Suite A",
            "city": "Du Quoin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628322442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Southern Illinois Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Illinois Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Du Quoin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.