NPIMap

Organization Active NPI

Trinity Health and Wellness, LLC.

  • Rural Health Clinic/Center
  • Louisville, IL
National Provider Identifier
1356857981
Registry record updated Jan 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TRINITY HEALTH AND WELLNESS, LLC.
Practice address
850 Bryant St
Louisville, IL 62858-1000
Phone
(314) 757-0140
NPI assigned
Dec 19, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2019

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

Authorized official

Name
Carrie Nussmeyer, APN, FNP-CNPI 1477914737
Title
Owner
Phone
(618) 665-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

850 Bryant St
Louisville, IL 62858-1000

Mailing address

850 Bryant St
Louisville, IL 62858-1000
Phone (618) 665-7000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180305000806 IL Part B Supplier - Clinic/Group Practice 9537420724 Receives reassigned benefits from 5 practitioners
Practice locations: Louisville, IL
O20190206001097 IL Part A Provider - Rural Health Clinic 9537420724 Practice locations: Louisville, IL

Rural health clinic certification: CCN 783846

Legal name
TRINITY HEALTH AND WELLNESS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 3, 2019
Last certification
Dec 3, 2019
Ownership / control type
2B
Organization structure
LLCProprietary
Incorporated
Dec 16, 2017 in IL
Enrollment address
850 Bryant St
Louisville, IL 62858-1000

National Provider Directory

National Provider Directory
Tax ID family
Trinity Health and Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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
Valerie Lybarger Individual 5% Or Greater Direct Ownership InterestVice President Mar 1, 2019 33.33%
Corporate OfficerVice President Mar 1, 2019
Corporate DirectorVice President Mar 1, 2019
W-2 Managing EmployeeVice President Mar 1, 2019
Angela Casolari Individual 5% Or Greater Direct Ownership InterestPresident Mar 1, 2019 33.33%
Corporate OfficerPresident Mar 1, 2019
Corporate DirectorPresident Mar 1, 2019
W-2 Managing EmployeePresident Mar 1, 2019
Carrie Nussmeyer Individual 5% Or Greater Direct Ownership InterestSecretary Mar 1, 2019 33.33%
Corporate OfficerSecretary Mar 1, 2019
Corporate DirectorSecretary Mar 1, 2019
W-2 Managing EmployeeSecretary Mar 1, 2019

Owners & managing parties with NPI records 3

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

  • Angela Casolari, APN
    • Family Nurse Practitioner
    • Flora, IL
    • NPI 1316338890

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Valerie L Lybarger, FNP-BC
    • Family Nurse Practitioner
    • Louisville, IL
    • NPI 1962892976

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Carrie Nussmeyer, APN, FNP-C
    • Family Nurse Practitioner
    • Louisville, IL
    • NPI 1477914737

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1356857981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 BRYANT ST",
            "city": "LOUISVILLE",
            "state": "IL",
            "postal_code": "628581000",
            "telephone_number": "618-665-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 BRYANT ST",
            "city": "LOUISVILLE",
            "state": "IL",
            "postal_code": "628581000",
            "telephone_number": "314-757-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH AND WELLNESS, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-19",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "NUSSMEYER",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-665-7000",
        "authorized_official_credential": "APN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, IL

Sources for this page

Verify at the official NPI Registry.