NPIMap

Organization Active NPI

County of Clay

Doing business as Clay County Hospital

  • Critical Access Hospital
  • Flora, IL
National Provider Identifier
1184655136
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
1813281 Issued in IL
Legal business name
COUNTY OF CLAY
Doing business as
Clay County Hospital
Practice address
911 Stacey Burk Dr
Flora, IL 62839-3241
Phone
(618) 662-2131
Fax
(618) 662-1482
NPI assigned
Jul 6, 2006
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Carrie Miller
Title
Chief Nursing Officer
Phone
(618) 662-2131

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 1744965 IL
Critical Access Hospital 282NC0060X 1813281 IL Primary

Addresses

Primary practice location

911 Stacey Burk Dr
Flora, IL 62839-3241

Mailing address

PO Box 280
Flora, IL 62839-0280
Phone (618) 662-2131

Other names 1

  • Clay County Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071220000378 IL Part A Provider - Critical Access Hospital 0042101982 Receives reassigned benefits from 64 practitioners
Practice locations: Flora, IL
O20180801002178 IL Part B Supplier - Hospital Department(S) 0042101982 Receives reassigned benefits from 109 practitioners
Practice locations: Flora, IL
O20230616000811 IL MDPP Supplier - in-Person MDPP Supplier 0042101982 Practice locations: Flora, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184655136. Details of each certification follow.

Hospital certification: CCN 141351

Legal name
COUNTY OF CLAY
Doing business as
CLAY COUNTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 21, 2005
Last certification
Feb 27, 2014
Beds
18
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
911 Stacy Burk Dr
Flora, IL 62839-3241

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Clay County HospitalCCN 141351 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Clay County Health Department9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

106 Edwards St
Newton, IL 62448
Phone (618) 783-4154

106 Edwards St
#2
Newton, IL 62448

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
County of Clay Organization, Flora, IL Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Jennifer Venable Individual Corporate OfficerChief Financial Officer Nov 20, 2017
Ariane Souder Individual Operational/Managerial ControlChief of Clinic Operations Aug 6, 2017
Jody Gillum Individual Corporate OfficerChief Nursing Officer Oct 13, 2022
W-2 Managing EmployeeChief Nursing Officer Oct 13, 2022

Owners & managing parties with NPI records 5

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

  • County of Clay

    dba CCH Pharmacy

    • Community/Retail Pharmacy
    • Flora, IL
    • NPI 1235990276

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Flora, IL
    • NPI 1336345578

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba CCH Medical Clinic

    • Rural Health Clinic/Center
    • Flora, IL
    • NPI 1811946411

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Louisville Medical Clinic

    • Rural Health Clinic/Center
    • Louisville, IL
    • NPI 1831120401

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay
    • Rural Health Clinic/Center
    • Clay City, IL
    • NPI 1871950550

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clay County HospitalFlora, IL, CCN 14Z351 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Louisville Medical ClinicLouisville, IL, CCN 143487 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2006
CCH Medical ClinicFlora, IL, CCN 143458 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2010
Clay City Medical ClinicClay City, IL, CCN 148558 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2016

Owned or controlled facilities with NPI records 4

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

  • County of Clay

    dba Clay County Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Flora, IL
    • NPI 1336345578

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba CCH Medical Clinic

    • Rural Health Clinic/Center
    • Flora, IL
    • NPI 1811946411

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Louisville Medical Clinic

    • Rural Health Clinic/Center
    • Louisville, IL
    • NPI 1831120401

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay
    • Rural Health Clinic/Center
    • Clay City, IL
    • NPI 1871950550

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 142

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 142

Affiliated clinicians 133

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

View all 133

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1184655136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628390280",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 STACEY BURK DR",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-1482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CLAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "618-662-2131"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "1744965",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "1813281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clay County Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clay County Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flora, IL

Sources for this page

Verify at the official NPI Registry.