NPIMap

Organization Active NPI

Salem Township Hospital

  • Critical Access Hospital
  • Salem, IL
National Provider Identifier
1295739548
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0002089 Issued in IL
Legal business name
SALEM TOWNSHIP HOSPITAL
Practice address
1201 Ricker Drive
Salem, IL 62881
Phone
(618) 548-3194
Fax
(618) 740-0122
NPI assigned
Jun 2, 2005
Last updated
Aug 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Authorized official

Name
Mr. James Timpe
Title
President/Ceo/Cfo
Phone
(618) 548-3194

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0002089 IL Primary
Rural Acute Care Hospital 282NR1301X 0002089 IL

Addresses

Primary practice location

1201 Ricker Drive
Salem, IL 62881

Mailing address

1201 Ricker Drive
Salem, IL 62881
Phone (618) 548-3194

Other identifiers 3

IdentifierTypeStateIssuer
5286399OtherILUNITED HEALTHCARE
102929OtherILHEALTHLINK
0183OtherILBLUE CROSS HOSPITAL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031126000688 IL Part B Supplier - Clinic/Group Practice 0840195277 Receives reassigned benefits from 42 practitioners
6 other NPIs on this enrollment
Practice locations: Salem, IL
O20061104000630 IL Part A Provider - Critical Access Hospital 0840195277 Receives reassigned benefits from 31 practitioners
Practice locations: Salem, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295739548. Details of each certification follow.

Hospital certification: CCN 141345

Legal name
SALEM TOWNSHIP HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2005
Last certification
Jan 10, 2013
Beds
25
Ownership / control type
Local
Organization structure
OtherProprietary
Incorporated
May 1, 1942 in IL
Enrollment address
1201 Ricker Rd
Salem, IL 62881-4263
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Salem Township HospitalCCN 141345 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Public Hosp of Salem6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Salem Township Hospital Organization, Salem, IL 5% Or Greater Direct Ownership Interest May 1, 2005 100%
Michael L Morton Individual Corporate DirectorGoverning Board Vice-Chairman Feb 1, 2010
Todd Woodruff Individual Corporate DirectorBoard Member Aug 1, 2015
Lisa Jane Ambuehl Individual Corporate OfficerInterim Ceo Jul 1, 2022
W-2 Managing EmployeeChief Nursing Officer Jul 1, 2022
Mark Clark Individual Corporate DirectorBoard Member May 1, 2018
Sandra Phillips Individual Corporate DirectorGoverning Board Chairman Jan 1, 2013
Amy Marsh Individual Corporate OfficerCfo Jul 31, 2023
W-2 Managing EmployeeCfo Jul 31, 2023

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Salem Township HospitalSalem, IL, CCN 14Z345 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2005
Salem Township Hospital Rural Health ClinicSalem, IL, CCN 143413 Rural health clinic Operational/Managerial Control Jul 1, 2018
STH Family Health Care CenterSalem, IL, CCN 148608 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 67

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 67

Affiliated clinicians 96

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

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1295739548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 RICKER DRIVE",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "62881",
            "telephone_number": "618-548-3194",
            "fax_number": "618-548-0924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 RICKER DRIVE",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "62881",
            "telephone_number": "618-548-3194",
            "fax_number": "618-740-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM TOWNSHIP HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-02",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "TIMPE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "618-548-3194",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0002089",
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "IL",
            "license": "0002089",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5286399",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "102929",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS HOSPITAL",
            "identifier": "0183",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, IL

Sources for this page

Verify at the official NPI Registry.