Fayette County
Organization Active NPI Home Health Agency · Vandalia, IL
NPI 1174523914 · NPPES record last updated Feb 2, 2017
Key facts
- NPI
- 1174523914
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 1625062 (IL)
- Legal business name
- FAYETTE COUNTY
- Practice address
- 416 W Edwards St
Vandalia, IL 62471-2706 - Phone
- (618) 283-7262
- Fax
- (618) 283-5039
- NPI assigned
- Jul 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Rhonda Andrews
- Title
- Administrator
- Phone
- (618) 283-1044
Owners & managing parties with NPI records 1
-
Glenn Skow, M.D., MPH, FAAFP
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 1
-
Lanie E Eagleton, M.D.
Affiliated clinicians 9
-
Michael Darmadi, MD
-
Brian W. Dossett, M.D.
-
Jeffrey J Jenson, M.D.
-
Deidre Langston, APN
-
Chester Nay, PA-C
-
John P. Opilka, D.O.
-
Glenn Skow, M.D., MPH, FAAFP
-
Bruce A Braswell, PA
Medicare Care Compare: Home health agency
- Listed as
- Fayette County Health Dept
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Government Operated
- Certified
- Aug 10, 1976
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare Care Compare: Hospice
- Listed as
- Fayette County Health Department Hospice
- Ownership
- Government
- Certified
- Sep 9, 2002
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Home health agency certification: CCN 147147
- Legal name
- FAYETTE COUNTY
- Doing business as
- FAYETTE COUNTY HEALTH DEPARTMENT
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Aug 10, 1976
- Last certification
- Sep 30, 2020
- Ownership / control type
- Government Operated
- Organization structure
- Government · Proprietary
- Enrollment address
- 416 W Edwards St
Vandalia, IL 62471-2706
Hospice certification: CCN 141607
- Legal name
- FAYETTE COUNTY
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 9, 2002
- Last certification
- Sep 24, 2020
- Ownership / control type
- Government - County
- Organization structure
- Government · Non-profit
- Enrollment address
- 416 West Edwards St
Vandalia, IL 62471-2706
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Kendra Craig |
W-2 Managing Employee |
Apr 30, 2021 | 100% |
| Operational/Managerial Control |
Apr 30, 2021 | 100% | |
| Corporate Director |
Apr 14, 2021 | 100% | |
| W-2 Managing Employee |
Apr 14, 2021 | 100% | |
| Glenn a Skow |
Contracted Managing Employee |
Jul 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100330000959 | IL | Part a Provider - Home Health Agency | 1658417365 | Practice locations: Vandalia, IL |
| O20110324000130 | IL | Part a Provider - Hospice | 1658417365 | Practice locations: Vandalia, IL |
National Provider Directory
- Tax ID family
- Fayette County Health D
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1625062 | IL | Yes |
| Community Based Hospice Care Agency | 251G00000X | 1863108 | IL |
Addresses
Primary practice location
416 W Edwards St
Vandalia, IL 62471-2706
Mailing address
416 W Edwards St
Vandalia, IL 62471-2706
Phone (618) 283-1044
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9819 | Other | IL | BC/BS |
| 136947 | Other | IL | HEALTH LINK |
| 50364 | Other | IL | BC/BS HOSPICE |
NPI Registry JSON
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1485993600000",
"number": "1174523914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 W EDWARDS ST",
"city": "VANDALIA",
"state": "IL",
"postal_code": "624712706",
"telephone_number": "618-283-1044",
"fax_number": "618-283-5038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 W EDWARDS ST",
"city": "VANDALIA",
"state": "IL",
"postal_code": "624712706",
"telephone_number": "618-283-7262",
"fax_number": "618-283-5039"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAYETTE COUNTY",
"organizational_subpart": "NO",
"enumeration_date": "2005-07-22",
"last_updated": "2017-02-02",
"status": "A",
"authorized_official_last_name": "ANDREWS",
"authorized_official_first_name": "RHONDA",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "618-283-1044",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "IL",
"license": "1625062",
"primary": true
},
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "IL",
"license": "1863108",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "9819",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH LINK",
"identifier": "136947",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS HOSPICE",
"identifier": "50364",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, IL
- Nicole Leigh Elam
- Kathleen Ann Emerick
- Janet Eileen Evans
- Fayco Enterprises Inc
- Fayette County
- Fayette County
- Fayette County Hospital
- Fayette County Hospital District
- Marissa Laurette Feeney
- Meri Brooke File-Miller
All providers in Vandalia, IL · Home Health Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.