NPIMap

Organization Active NPI

Proctor Community Hospital

  • Rehabilitation Hospital Unit
  • Peoria, IL
National Provider Identifier
1134826894
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
PROCTOR COMMUNITY HOSPITAL
Practice address
5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone
(309) 691-1000
NPI assigned
Feb 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Authorized official

Name
Dr. Keith Knepp, D.O.NPI 1982623666
Title
Ceo
Phone
(309) 671-2528

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Primary

Addresses

Primary practice location

5409 N Knoxville Ave
Peoria, IL 61614-5069

Mailing address

5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone (309) 691-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100326000135 IL Part A Provider - Hospital 9537077391 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmington, IL; Peoria, IL
O20230928000385 IL Part A Provider - Hospital 9537077391 Practice locations: Peoria, IL

Hospital certification: CCN 140013

Legal name
PROCTOR COMMUNITY HOSPITAL
Doing business as
CARLE HEALTH PROCTOR HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 16, 2020
Beds
305 (285 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1966 in IL
Enrollment address
5409 N Knoxville Ave
Peoria, IL 61614-5069
Other Hospital Practice Location
Hospital subgroups
Acute care, Rehabilitation

Hospital certification: CCN 14T013

Legal name
PROCTOR COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1966 in IL
Enrollment address
5049 N Knoxville Ave
Peoria, IL 61614-5069
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Carle Health Proctor HospitalCCN 140013
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Carle Health Proctor HospitalCCN 14T013
Ownership
Non-profit
Certified
Jan 1, 2024

National Provider Directory

National Provider Directory
Tax ID family
Belcrest LTD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

723 N 2nd St
Chillicothe, IL 61523
Phone (309) 274-5380

50 E Fort St
Farmington, IL 61531
Phone (309) 889-0787

5409 N Knoxville Ave
Peoria, IL 61614
Phone (309) 691-1000

5401 N Knoxville Ave
Ste 20
Peoria, IL 61614
Phone (309) 691-1043

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Terry L Waters Individual Corporate Director Jan 1, 2024
Dennis R Triggs Individual Corporate Director Jan 1, 2021
Melissa Yoder Individual Corporate Director Jan 1, 2022
Keila Sierra-Cintron Individual Corporate Director Jan 1, 2024
Deveraux Hubbard Individual Corporate Director Jan 1, 2025
Aron T Klein Individual Corporate Director Jan 25, 2025
W-2 Managing Employee Jan 25, 2025
Rich R Kriegsman Individual Corporate DirectorChair Jan 1, 2018
Brandon Moss Individual Corporate Director Jan 1, 2025
Becki Salmon Individual Corporate Director Jan 1, 2025
Jeanine Spain Individual Corporate Director Jan 1, 2025
Deborah R Simon Individual Corporate Director Jan 1, 2023
Carle Health - West Region Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2025 100%
Operational/Managerial Control Apr 1, 2023 100%
Matthew Craig Kolb Individual Corporate Director Apr 1, 2023
Keith Knepp Individual Corporate OfficerCeo Jan 1, 2015
Corporate DirectorCeo Jan 1, 2015
W-2 Managing EmployeeCeo Jan 1, 2015
Dirk W Roecker Individual Corporate Director Jan 1, 2021
Aaron Kilgore Individual Corporate Director Jan 1, 2022
James D Stevenson Individual Corporate Director Jan 1, 2021
Jeffrey Leman Individual Corporate Director Jan 1, 2024
Kevin Barbier Individual Corporate Director Jan 1, 2021
James C Leonard Individual Operational/Managerial ControlPresient & Ceo Apr 4, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 412

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 412

NPI Registry JSON

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

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1134826894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5409 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145069",
            "telephone_number": "309-691-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145069",
            "telephone_number": "309-691-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCTOR COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "KNEPP",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-671-2528",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.