NPIMap

Organization Active NPI

Julia Rackley Perry Memorial Hospital

Doing business as Perry Memorial Hospital

  • Critical Access Hospital
  • Princeton, IL
National Provider Identifier
1124021308
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0001883 Issued in IL
Legal business name
JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Doing business as
Perry Memorial Hospital
Practice address
530 Park Ave E
Princeton, IL 61356-3901
Phone
(815) 875-2811
Fax
(815) 876-4455
NPI assigned
May 23, 2005
Last updated
Mar 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Authorized official

Name
Jean Welte
Title
Medical Staff Services Coordinator
Phone
(815) 876-2293

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0001883 IL Primary

Addresses

Primary practice location

530 Park Ave E
Princeton, IL 61356-3901

Mailing address

530 Park Ave E
Princeton, IL 61356-3901
Phone (815) 875-2811

Other identifiers 5

IdentifierTypeStateIssuer
001193OtherILHEALTH ALLIANCE
A61356001OtherILJOHN DEERE
122OtherILBLUE CROSS
336006057001MedicaidIL
336006057401MedicaidIL

Other names 1

  • Perry Memorial Hospital Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1124021308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-875-2811",
            "fax_number": "815-876-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-875-2811",
            "fax_number": "815-876-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JULIA RACKLEY PERRY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "WELTE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "MEDICAL STAFF SERVICES COORDINATOR",
        "authorized_official_telephone_number": "815-876-2293"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0001883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "001193",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "A61356001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "122",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336006057001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336006057401",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perry Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perry Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.