NPIMap

Organization Active NPI

SJL Health Systems Inc

Doing business as Prairie Rose Health Care Center

  • Skilled Nursing Facility
  • Pana, IL
National Provider Identifier
1215037353
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0045245 Issued in IL
Legal business name
SJL HEALTH SYSTEMS INC
Doing business as
Prairie Rose Health Care Center
Practice address
900 S Chestnut St
Pana, IL 62557-9730
Phone
(217) 562-3996
Fax
(217) 562-4005
NPI assigned
Sep 25, 2006
Last updated
Feb 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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

Authorized official

Name
Mark B. Petersen
Title
President
Phone
(309) 691-8113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0045245 IL Primary

Addresses

Primary practice location

900 S Chestnut St
Pana, IL 62557-9730

Mailing address

830 W Trailcreek Dr
Peoria, IL 61614-1862
Phone (309) 691-8113

Other names 1

  • Prairie Rose Health Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100116000275 IL Part B Supplier - Clinic/Group Practice 5092857821 Receives reassigned benefits from 344 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20111116000182 IL Part B Supplier - Mass Immunization (Roster Biller Only) 5890771372 Practice locations: Pana, IL

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

2965 N Main St
Ste F
Decatur, IL 62526
Phone (217) 875-7847

5 Ludwig Dr
Fairview Heights, IL 62208
Phone (618) 397-9000

101 Coles Centre Dr
Mattoon, IL 61938
Phone (217) 234-5110

775 Sunset Blvd
#B
O Fallon, IL 62269
Phone (618) 235-8500

2901 Old Jacksonville Rd
Ste B4
Springfield, IL 62704
Phone (217) 241-3586

Practitioners & affiliated clinicians

Practitioners 89

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 89

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1215037353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W TRAILCREEK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141862",
            "telephone_number": "309-691-8113",
            "fax_number": "309-691-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S CHESTNUT ST",
            "city": "PANA",
            "state": "IL",
            "postal_code": "625579730",
            "telephone_number": "217-562-3996",
            "fax_number": "217-562-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJL HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0045245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Rose Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.