NPIMap

Organization Active NPI

Thomas H. Boyd Memorial Hospital

Doing business as Thomas H. Boyd Rural Health Clinic

  • Rural Health Clinic/Center
  • Carrollton, IL
National Provider Identifier
1164507604
Registry record updated May 21, 2025
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
Thomas H. Boyd Rural Health Clinic
Practice address
803 5TH St
Carrollton, IL 62016-1405
Phone
(217) 942-3600
Fax
(217) 942-3785
NPI assigned
Oct 25, 2006
Last updated
May 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THOMAS H. BOYD MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2025

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 Primary

Addresses

Primary practice location

803 5TH St
Carrollton, IL 62016-1405

Mailing address

803 5TH St
Carrollton, IL 62016-1405
Phone (217) 942-3600

Other names 1

  • Thomas H. Boyd Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080910000236 IL Part A Provider - Rural Health Clinic 8123085560 Practice locations: Carrollton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164507604. Details of each certification follow.

Rural health clinic certification: CCN 143475

Legal name
THOMAS H BOYD MEMORIAL HOSPITAL
Doing business as
THOMAS H. BOYD RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 3, 2005
Last certification
Mar 27, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1941 in IL
Enrollment address
803 5TH St
Carrollton, IL 62016-1405
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
14D0899007Thomas H Boyd Rural Health Clinic803 Fifth Street, Carrollton, IL 62016Certificate of waiverMar 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Boyd Mem Hosp5 organizations share this tax ID, including this one
Part of
Boyd Mem Hosp

Other organizations with this tax ID 4

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

Locations

727 9th St
Carrollton, IL 62016
Phone (217) 942-6612

803 5th St
Carrollton, IL 62016
Phone (217) 942-3600

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 Director Jul 1, 2022
Raymond Beavers Individual Corporate Director Feb 1, 2016
Kathryn Garner Individual Corporate Officer Nov 19, 2022
W-2 Managing Employee Nov 19, 2022
Operational/Managerial Control Nov 19, 2022
Mary Tunison Individual Corporate Director Jun 17, 2002
Diane Wolfley Individual Corporate Director Aug 13, 2008
Stacy D Holland Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Mary Plummer Individual Corporate Director Dec 1, 2018
Kirby Ballard Individual Corporate Director 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 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1164507604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 5TH ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161405",
            "telephone_number": "217-942-3600",
            "fax_number": "217-942-9349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 5TH ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161405",
            "telephone_number": "217-942-3600",
            "fax_number": "217-942-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS H. BOYD MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THOMAS H. BOYD MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-25",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas H. Boyd Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, IL

Sources for this page

Verify at the official NPI Registry.