NPIMap

Organization Active NPI

Richland Memorial Hospital, Inc

Doing business as Carle RMH Primary Care

  • Rural Health Clinic/Center
  • Olney, IL
National Provider Identifier
1326566290
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RICHLAND MEMORIAL HOSPITAL, INC
Doing business as
Carle RMH Primary Care
Practice address
605 E Main St
Olney, IL 62450-2163
Phone
(618) 392-1140
NPI assigned
Aug 31, 2017
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Harry Brockus
Title
Ceo
Phone
(618) 395-7340

Specialties & licenses 1

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

Addresses

Primary practice location

605 E Main St
Olney, IL 62450-2163

Mailing address

800 E Locust St
Olney, IL 62450-2553

Other names 1

  • CARLE RMH PRIMARY CARE Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040811000131 IL Part B Supplier - Clinic/Group Practice 3870565732 Receives reassigned benefits from 300 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flora, IL; West Salem, IL; Urbana, IL; Robinson, IL; Olney, IL; Newton, IL; Mount Carmel, IL; Lawrenceville, IL…
O20171214000065 IL Part A Provider - Rural Health Clinic 3870565732 Practice locations: Olney, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326566290. Details of each certification follow.

Rural health clinic certification: CCN 148584

Legal name
RICHLAND MEMORIAL HOSPITAL INC
Doing business as
CARLE RMH PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 15, 2018
Last certification
Mar 15, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 30, 1996 in IL
Enrollment address
363 N West St
Olney, IL 62450-1160
Related CCNs
140147

Other NPIs with the same Medicare PAC ID 6

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.

National Provider Directory

National Provider Directory
Tax ID family
Richland Memorial Hospital Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

363 N West St
Olney, IL 62450
Phone (618) 392-9400

605 E Main St
Olney, IL 62450
Phone (618) 392-1140

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Brian L Atwood Individual Corporate DirectorBoard Member Jan 1, 2019
Steven T Thomson Individual Corporate DirectorBoard Member Oct 1, 2022
Larry D Dunn Individual Corporate Director Oct 26, 2021
Tanner M Miller Individual Corporate DirectorBoard Member Jan 1, 2022
Raymond L Fisher Individual Corporate DirectorBoard Member Oct 1, 2020
Sherry L Geier Individual Corporate Director Oct 26, 2021
Bernard Eugene Brauer Individual Corporate DirectorBoard Member Oct 1, 2022
Regina Rachel Thomas Individual Corporate OfficerInterim President/Ceo Mar 4, 2021
W-2 Managing EmployeeInterim President/Ceo Mar 4, 2021
Jennifer Cummins-Zuber Individual Corporate DirectorBoard Member Oct 23, 2018
Gary Houchin Individual Corporate DirectorBoard Member Oct 23, 2018
Patricia Lynn Kessler-Bookhout Individual Corporate DirectorBoard Member Oct 1, 2019
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2017 100%
Matthew Craig Kolb Individual Corporate DirectorBoard Member Jun 7, 2019
Christina Bare Individual W-2 Managing EmployeeDirector Business Operations Dec 1, 2016
James C Leonard Individual Other Sep 1, 2017

Owners & managing parties with NPI records 4

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 84

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 84

NPI Registry JSON

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

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1326566290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E LOCUST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E MAIN ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502163",
            "telephone_number": "618-392-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHLAND MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "BROCKUS",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-395-7340"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARLE RMH PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CARLE RMH PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olney, IL

Sources for this page

Verify at the official NPI Registry.