Memorial Hospital Association

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MEMORIAL HOSPITAL ASSOCIATION

Practice address

204 Center St
Augusta, IL 62311-1228

Phone

(217) 392-2108

Fax

(217) 392-2110

NPI assigned

May 20, 2013

Organization subpart

Yes

Parent organization

MEMORIAL HOSPITAL ASSOCIATIONAs reported in NPPES

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

Authorized official

Name

Jessie Fifer

Title

Special Projects Coordinator

Phone

(217) 357-6594

Specialties & licenses 2

Addresses

Other names 1

• Memorial Medical Augusta Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• Memorial Hospital Association

  • Rural Health Clinic/Center
  • Carthage, IL
  • NPI 1205887742

  O20031126000246

  Same enrollment
• Memorial Hospital Association

  • Rural Health Clinic/Center
  • Carthage, IL
  • NPI 1588614002

  O20031126000246

  Same enrollment
• Memorial Hospital Association

  • Rural Health Clinic/Center
  • Colchester, IL
  • NPI 1699228882

  O20031126000246

  Same enrollment
• Memorial Hospital Association

  • Critical Access Hospital
  • Carthage, IL
  • NPI 1730139031

  O20031126000246

  Same enrollment
• Memorial Hospital Association

  • Rural Health Clinic/Center
  • Nauvoo, IL
  • NPI 1891972451

  O20031126000246

  Same enrollment

Part of

Memorial Hospital Association

Practitioners 1

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

• Victoria Kalivoda -Popela, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Monmouth, IL
  • NPI 1063408631
  NPD

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

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1275979031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623210160",
            "telephone_number": "217-357-6512",
            "fax_number": "217-357-6544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 CENTER ST",
            "city": "AUGUSTA",
            "state": "IL",
            "postal_code": "623111228",
            "telephone_number": "217-392-2108",
            "fax_number": "217-392-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL ASSOCIATION",
        "enumeration_date": "2013-05-20",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "FIFER",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "SPECIAL PROJECTS COORDINATOR",
        "authorized_official_telephone_number": "217-357-6594"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Medical Augusta Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luanne Dee Johnson, NURSE PRACTITIONER
• Karen Jane Land, A.R.N.P.
• Charles William Miller, DDS

• Family Nurse Practitioner in Augusta, IL
• Providers in Augusta, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; 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.