NPIMap

Organization Active NPI

County of Clay

  • Community/Retail Pharmacy
  • Flora, IL
National Provider Identifier
1235990276
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COUNTY OF CLAY
Practice address
929 Stacy Burk Drive
Flora, IL 62839
Phone
(618) 662-1600
Fax
(618) 844-8625
NPI assigned
Jan 17, 2024
Organization subpart
Yes
Parent organization
COUNTY OF CLAYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Authorized official

Name
Jennifer Venable
Title
Cfo
Phone
(618) 662-2191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

929 Stacy Burk Drive
Flora, IL 62839

Mailing address

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

Other names 1

  • CCH Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240514002184 IL Part B Supplier - Pharmacy 0042101982 Practice locations: Flora, IL

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Clay County Hospital9 organizations share this tax ID, including this one
Part of
Clay County Hospital

Other organizations with this tax ID 8

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

800 Kelly Dr SW
Clay City, IL 62824
Phone (217) 347-7179

929 Stacey Burk Dr
Ste 302
Flora, IL 62839
Phone (618) 662-1600

14265 Highway 45
Louisville, IL 62858

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Clay County HospitalFlora, IL, CCN 141351 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
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 5

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

Practitioners & affiliated clinicians

Practitioners 132

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 132

NPI Registry JSON

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

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1235990276",
    "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": "929 STACY BURK DRIVE",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "62839",
            "telephone_number": "618-662-1600",
            "fax_number": "618-844-8625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CLAY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF CLAY",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "VENABLE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-662-2191"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCH Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flora, IL

Sources for this page

Verify at the official NPI Registry.