NPIMap

Organization Active NPI

Pinckneyville Community Hospital

Doing business as Family Medical Center

  • Rural Health Clinic/Center
  • Pinckneyville, IL
National Provider Identifier
1306818844
Registry record updated Jan 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PINCKNEYVILLE COMMUNITY HOSPITAL
Doing business as
Family Medical Center
Practice address
5383 State Route 154
Pinckneyville, IL 62274-3342
Phone
(618) 357-2187
Fax
(618) 357-8888
NPI assigned
Feb 7, 2006
Last updated
Jan 26, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PINCKNEYVILLE COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2016

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

Authorized official

Name
Mrs. Kara Jo Carson
Title
Cfo
Phone
(618) 357-2187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

5383 State Route 154
Pinckneyville, IL 62274-3342

Mailing address

5383 State Route 154
Pinckneyville, IL 62274-3342
Phone (618) 357-2187

Other identifiers 3

IdentifierTypeStateIssuer
07320380OtherILBCBS
342557OtherILHEALTHLINK
CI9857OtherILMEDICARE RAILROAD

Other names 1

  • Family Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040131000065 IL Part B Supplier - Clinic/Group Practice 8123921632 Receives reassigned benefits from 47 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pinckneyville, IL
O20080506000355 IL Part A Provider - Rural Health Clinic 8123921632 Practice locations: Pinckneyville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306818844. Details of each certification follow.

Rural health clinic certification: CCN 143412

Legal name
PINCKNEYVILLE COMMUNITY HOSPITAL
Doing business as
FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 27, 1996
Last certification
Dec 26, 2019
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Mar 15, 1951 in IL
Enrollment address
5383 State Route 154
Pinckneyville, IL 62274-3342
Related CCNs
141307

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

Other NPIs with the same Medicare PAC ID 2

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.

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
14D0906748Family Medical Center/Pinckneyville5383 State Route 154, Pinckneyville, IL 62274Provider-performed microscopyJan 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pinckneyville Comm Hosp15 organizations share this tax ID, including this one
Part of
Pinckneyville Comm Hosp

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Kara Carson Individual W-2 Managing Employee Mar 24, 2008
Pinckneyville Community Hospital Organization, Pinckneyville, IL Created for acquisition 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Randall W Dauby Individual W-2 Managing EmployeeAdministrator/Ceo Jul 15, 2015

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Pinckneyville Community HospitalPinckneyville, IL, CCN 141307 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Pinckneyville Community HospitalPinckneyville, IL, CCN 14Z307 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1306818844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5383 STATE ROUTE 154",
            "city": "PINCKNEYVILLE",
            "state": "IL",
            "postal_code": "622743342",
            "telephone_number": "618-357-2187",
            "fax_number": "618-357-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5383 STATE ROUTE 154",
            "city": "PINCKNEYVILLE",
            "state": "IL",
            "postal_code": "622743342",
            "telephone_number": "618-357-2187",
            "fax_number": "618-357-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINCKNEYVILLE COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINCKNEYVILLE COMMUNITY HOSPITAL",
        "enumeration_date": "2006-02-07",
        "last_updated": "2016-01-26",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "KARA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-357-2187",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07320380",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "342557",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CI9857",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pinckneyville, IL

Sources for this page

Verify at the official NPI Registry.