Active NPI
Fayette County
- Home Health Agency
- Vandalia, IL
National Provider Identifier
1174523914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 1625062
- 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
- Last updated
- Feb 2, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Rhonda Andrews
- Title
- Administrator
- Phone
- (618) 283-1044
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1625062 | IL | Primary |
| 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 2
| 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 |
NPI to CCN mapping 2
The Medicare certification numbers (CCNs) connected to NPI 1174523914. Details of each certification follow.
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
- 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
- Enrollment address
- 416 West Edwards St
Vandalia, IL 62471-2706
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Fayette County Health Dept
- Overall star rating
- Ownership
- Government Operated
- Certified
- Aug 10, 1976
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Care Compare: Hospice
Medicare Care Compare- Listed as
- Fayette County Health Department Hospice
- Ownership
- Government
- Certified
- Sep 9, 2002
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Fayette County Health D
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Public Health or Welfare Agency
- Vandalia, IL
- NPI 1033386271
-
- Community Based Hospice Care Agency
- Vandalia, IL
- NPI 1851556237
Locations
416 W Edwards St
Vandalia, IL 62471
Phone (618) 283-1044
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| 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 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Emergency Medicine Physician
- Vandalia, IL
- NPI 1396987053
Contracted Managing Employee
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Pulmonary Disease Physician
- Springfield, IL
- NPI 1205824059
Affiliated clinicians 9
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"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": [],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.