NPIMap

Organization Active NPI

Thomas H. Boyd Memorial Hospital

  • Rural Health Clinic/Center
  • Carrollton, IL
National Provider Identifier
1366535304
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THOMAS H. BOYD MEMORIAL HOSPITAL
Practice address
727 9TH St
Carrollton, IL 62016-1427
Phone
(217) 942-6612
Fax
(217) 942-6613
NPI assigned
Oct 2, 2006
Organization subpart
Yes
Parent organization
THOMAS H. BOYD MEMORIAL HOSPITALAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Stace Holland
Title
Ceo
Phone
(217) 942-6946

Owners & managing parties with NPI records 5

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

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 4

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

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

Practitioners 31

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

View all 31

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
14D2326747Greene County Rural Health Clinic727 9TH Street, Carrollton, IL 62016Certificate of waiverJul 8, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Rural health clinic certification: CCN 143403

Medicare enrollment files
Legal name
THOMAS H BOYD MEMORIAL HOSPITAL
Doing business as
GREENE COUNTY RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 22, 1995
Last certification
Nov 9, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1941 in IL
Enrollment address
727 9TH St
Carrollton, IL 62016-1427
Related CCNs
141300

All disclosed owners & managing parties 9

Medicare enrollment files

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

NameRoleSinceShare
Jenny Clough Individual Corporate DirectorBoard of Trustees Oct 1, 2022
Raymond Beavers Individual Corporate Director Feb 1, 2016
Kathryn Garner Individual Corporate OfficerCfo Nov 19, 2022
W-2 Managing EmployeeCfo Nov 19, 2022
Mary Tunison Individual Corporate Director Jun 17, 2002
Diane Wolfley Individual Corporate Director Dec 1, 2004
Stacy D Holland Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Thomas H Boyd Memorial Hospital Organization, Carrollton, IL Non-profit Operational/Managerial Control Jun 21, 2010
Mary Plummer Individual Corporate Director Jan 1, 2019
Kirby Ballard Individual Corporate Director Sep 25, 2017

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20100729000528 IL Part a Provider - Rural Health Clinic 8123085560 Practice locations: Carrollton, IL

National Provider Directory

National Provider Directory
Tax ID family
Boyd Mem Hosp (5 organizations share this tax ID)
Part of
Boyd Mem Hosp

Locations

803 5th St
Carrollton, IL 62016
Phone (217) 942-3600

116A N Main St
White Hall, IL 62092
Phone (217) 374-2188

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

727 9TH St
Carrollton, IL 62016-1427

Mailing address

727 9TH St
Carrollton, IL 62016-1427
Phone (217) 942-6612

Other names 1

NPPES NPI Registry
  • Greene County Rural Health Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 22, 2024.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1366535304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 9TH ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161427",
            "telephone_number": "217-942-6612",
            "fax_number": "217-942-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 9TH ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161427",
            "telephone_number": "217-942-6612",
            "fax_number": "217-942-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS H. BOYD MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THOMAS H. BOYD MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "STACE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-942-6946"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greene County Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greene County Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, IL

Sources for this page

Verify at the official NPI Registry.