NPIMap

Organization Active NPI

Pekin Memorial Hospital

Doing business as Pekin Hospital

  • General Acute Care Hospital
  • Pekin, IL
National Provider Identifier
1245227479
Registry record updated Jul 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0001834 Issued in IL
Legal business name
PEKIN MEMORIAL HOSPITAL
Doing business as
Pekin Hospital
Practice address
600 S 13TH St
Pekin, IL 61554-4936
Phone
(309) 347-1151
Fax
(309) 347-1240
NPI assigned
Oct 3, 2005
Last updated
Jul 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2012

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

Authorized official

Name
Mr. Gary Jepson
Title
Ceo
Phone
(309) 353-0700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0001834 IL Primary

Addresses

Primary practice location

600 S 13TH St
Pekin, IL 61554-4936

Mailing address

600 S 13TH St
Pekin, IL 61554-4936
Phone (309) 347-1151

Other names 1

  • Pekin Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040401000798 IL Part B Supplier - Clinic/Group Practice 4789676438 Receives reassigned benefits from 42 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pekin, IL
O20070508000398 IL Part A Provider - Hospital 4789676438 Practice locations: Pekin, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245227479. Details of each certification follow.

Hospital certification: CCN 140120

Legal name
PEKIN MEMORIAL HOSPITAL
Doing business as
CARLE HEALTH PEKIN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 24, 1999
Beds
132
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
600 S 13TH St
Pekin, IL 61554-4936
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Carle Health Pekin HospitalCCN 140120 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Pekin Hospital-Crna4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

2934 Court St
Pekin, IL 61554
Phone (309) 353-0400

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Terry L Waters Individual Corporate Director Jan 1, 2022
Dennis R Triggs Individual Corporate Director Jan 1, 2021
Melissa Yoder Individual Corporate Director Jan 1, 2022
Keila Sierra-Cintron Individual Corporate Director Jan 1, 2024
Deveraux Hubbard Individual Corporate Director Jan 1, 2025
Aron T Klein Individual Corporate OfficerCfo Feb 25, 2025
W-2 Managing Employee Feb 25, 2025
Operational/Managerial Control Feb 25, 2025
Rich R Kriegsman Individual Corporate Director Jan 1, 2021
Brandon Moss Individual Corporate Director Jan 1, 2025
Becki Salmon Individual Corporate Director Jan 1, 2025
Jeanine Spain Individual Corporate Director Jan 1, 2025
Deborah R Simon Individual Corporate Director Jan 1, 2023
Carle Health - West Region Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 1, 2023 100%
Matthew Craig Kolb Individual Corporate Director Apr 1, 2023
Keith Knepp Individual Corporate DirectorRegional Ceo Jul 1, 2019
W-2 Managing EmployeeRegional Ceo Jul 1, 2019
Operational/Managerial ControlRegional Ceo Jul 1, 2019
Dirk W Roecker Individual Corporate Director Jan 1, 2021
Aaron Kilgore Individual Corporate Director Jan 1, 2022
James D Stevenson Individual Corporate Director Jan 1, 2021
Jeffrey Leman Individual Corporate Director Jan 1, 2024
Kevin Barbier Individual Corporate Director Jan 1, 2021
James C Leonard Individual Operational/Managerial ControlPresident & Ceo Apr 1, 2023

Owners & managing parties with NPI records 2

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

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 43

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 43

Affiliated clinicians 327

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

View all 327

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341532800000",
    "number": "1245227479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S 13TH ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544936",
            "telephone_number": "309-347-1151",
            "fax_number": "309-347-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 13TH ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544936",
            "telephone_number": "309-347-1151",
            "fax_number": "309-347-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEKIN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2012-07-06",
        "status": "A",
        "authorized_official_last_name": "JEPSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-353-0700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0001834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pekin Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pekin, IL

Sources for this page

Verify at the official NPI Registry.