NPIMap

Organization Active NPI

Wabash General Hospital District

Doing business as Wabash General Hospital Primary Care

  • Rural Health Clinic/Center
  • Mount Carmel, IL
National Provider Identifier
1114491875
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WABASH GENERAL HOSPITAL DISTRICT
Doing business as
Wabash General Hospital Primary Care
Practice address
1106 Oak St
Mount Carmel, IL 62863-2444
Phone
(618) 263-6575
NPI assigned
Jan 16, 2019
Last updated
Sep 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Authorized official

Name
Ms. Karissa Lynn Turner
Title
Ceo
Phone
(618) 262-8621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1106 Oak St
Mount Carmel, IL 62863-2444

Mailing address

1418 College Dr
Mount Carmel, IL 62863-2638
Phone (618) 263-6379

Other names 1

  • Wabash General Hospital Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190411000850 IL Part A Provider - Rural Health Clinic 8022908185 Practice locations: Mount Carmel, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114491875. Details of each certification follow.

Rural health clinic certification: CCN 148599

Legal name
WABASH GENERAL HOSPITAL DISTRICT
Doing business as
WABASH GENERAL HOSPITAL PRIMARY CARE OAK ST. LOCATION
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2019
Last certification
Nov 7, 2016
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1949 in IL
Enrollment address
1106 Oak St
Mount Carmel, IL 62863-2444
Related CCNs
141327

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0436182Wabash General Hospital District1106 Oak Street, Mount Carmel, IL 62863Certificate of waiverMar 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Wabash General Hospital District11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1106 Oak St
Mount Carmel, IL 62863
Phone (618) 263-6575

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Karissa L Turner Individual Corporate OfficerCeo Jan 1, 2019
Kevin E Raber Individual Corporate DirectorBoard Member Apr 2, 2018
Larry L Briggs Individual Corporate DirectorBoard Member Feb 1, 1992
Toni L Brines Individual Corporate DirectorBoard Member Jan 1, 2015
Janet L Storey Individual Corporate DirectorBoard Member Jan 1, 1989
Stephen D McGill Individual Corporate OfficerCfo Jan 1, 2019
William Easton Individual Corporate DirectorBoard Member Oct 1, 2010
Doug McPherson Individual Corporate DirectorBoard Member Mar 21, 2016
John a Evans Individual Corporate DirectorBoard Member Feb 1, 2009
Robert J Coleman Individual Corporate DirectorBoard Member Jan 1, 1995
Tara Gould Individual W-2 Managing EmployeeCoo Jul 1, 2019
Nathan Stevenson Individual Corporate DirectorBoard Member Feb 6, 2017

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wabash General Hospital-Dba-Convenient CareMount Carmel, IL, CCN 148501 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 4, 2002

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2019 Change of OwnershipThis provider was the buyer S B Jani MD PCCCN 148970, IL, NPI 1952588642

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1114491875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 COLLEGE DR",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628632638",
            "telephone_number": "618-263-6379",
            "fax_number": "618-263-6467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 OAK ST",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628632444",
            "telephone_number": "618-263-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WABASH GENERAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "KARISSA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-262-8621",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wabash General Hospital Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Carmel, IL

Sources for this page

Verify at the official NPI Registry.