NPIMap

Organization Active NPI

Thomas H. Boyd Memorial Hospital

Doing business as Rural Health Center of Roodhouse

  • Rural Health Clinic/Center
  • Roodhouse, IL
National Provider Identifier
1144313180
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THOMAS H. BOYD MEMORIAL HOSPITAL
Doing business as
Rural Health Center of Roodhouse
Practice address
132 W Lorton St
Roodhouse, IL 62082-1569
Phone
(217) 589-4629
Fax
(217) 589-4070
NPI assigned
Oct 2, 2006
Last updated
Apr 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Stace Holland
Title
Ceo
Phone
(217) 942-6946

Specialties & licenses 1

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

Addresses

Primary practice location

132 W Lorton St
Roodhouse, IL 62082-1569

Mailing address

132 W Lorton St
Roodhouse, IL 62082-1569
Phone (217) 589-4629

Other names 1

  • Rural Health Center of Roodhouse Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050822000141 IL Part A Provider - Rural Health Clinic 8123085560 Practice locations: Roodhouse, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144313180. Details of each certification follow.

Rural health clinic certification: CCN 143476

Legal name
THOMAS H BOYD MEMORIAL HOSPITAL
Doing business as
RURAL HEALTH CLINIC OF ROODHOUSE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 5, 2005
Last certification
Apr 10, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1941 in IL
Enrollment address
132W Lorton St
Roodhouse, IL 62082-1569
Related CCNs
141300

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

Other NPIs with the same Medicare PAC ID 5

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
14D0992793Rural Health Center of Roodhouse132 W Lorton, Roodhouse, IL 62082Provider-performed microscopyOct 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Boyd Mem Hosp5 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.

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/thomash-f0de34dd

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jenny Clough Individual Corporate DirectorBoard of Trustees Oct 1, 2022
Raymond Beavers Individual Corporate DirectorBoard of Trustees Feb 1, 2016
Kathryn Garner Individual Corporate OfficerCfo Nov 19, 2022
W-2 Managing EmployeeCfo Nov 19, 2022
Mary Tunison Individual Corporate DirectorBoard of Trustees Jun 17, 2002
Diane Wolfley Individual Corporate DirectorBoard of Trustees Dec 1, 2004
Stacy D Holland Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Operational/Managerial ControlCeo Apr 22, 2024
Mary Plummer Individual Corporate DirectorBoard of Trustees Dec 1, 2018
Kirby Ballard Individual Corporate DirectorBoard of Trustees Sep 25, 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
Greene County Rural Health ClinicCarrollton, IL, CCN 143403 Rural health clinic Operational/Managerial Control Jun 21, 2010

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1144313180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 W LORTON ST",
            "city": "ROODHOUSE",
            "state": "IL",
            "postal_code": "620821569",
            "telephone_number": "217-589-4629",
            "fax_number": "217-589-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 W LORTON ST",
            "city": "ROODHOUSE",
            "state": "IL",
            "postal_code": "620821569",
            "telephone_number": "217-589-4629",
            "fax_number": "217-589-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS H. BOYD MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "STACE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-942-6946"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Center of Roodhouse",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roodhouse, IL

Sources for this page

Verify at the official NPI Registry.