NPIMap

Organization Active NPI

Iroquois Memorial Hospital and Resident Home

Doing business as IMH St. Anne Clinic

  • General Practice Physician
  • Saint Anne, IL
National Provider Identifier
1215650528
Registry record updated May 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Doing business as
IMH St. Anne Clinic
Practice address
135 W Station St
Saint Anne, IL 60964-7251
Phone
(815) 432-5841
NPI assigned
Sep 21, 2022
Last updated
May 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2023

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

Authorized official

Name
Michelle Fox
Title
Director Medical Staff & It SVCS
Phone
(815) 432-5841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

135 W Station St
Saint Anne, IL 60964-7251

Mailing address

200 E Fairman Ave
Watseka, IL 60970-1644
Phone (815) 432-7775

Other names 1

  • IMH St. Anne Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040517000306 IL Part B Supplier - Clinic/Group Practice 4385551258 Receives reassigned benefits from 75 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Anne, IL; Watseka, IL

Other NPIs on the same Medicare enrollment 5

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

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
14D2286737Imh St Anne Clinic135 W Station St, Saint Anne, IL 60964Certificate of waiverAug 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Iroquois Memorial Hospital Resident Home15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685059200000",
    "number": "1215650528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E FAIRMAN AVE",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701644",
            "telephone_number": "815-432-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 W STATION ST",
            "city": "SAINT ANNE",
            "state": "IL",
            "postal_code": "609647251",
            "telephone_number": "815-432-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR MEDICAL STAFF & IT SVCS",
        "authorized_official_telephone_number": "815-432-5841"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMH St. Anne Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IMH St. Anne Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Anne, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.