NPIMap

Organization Active NPI

HSHS Good Shepherd Hospital Inc

Doing business as Shelby Memorial Hospital N H

  • Skilled Nursing Facility
  • Shelbyville, IL
National Provider Identifier
1376557983
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0015677 Issued in IL
Legal business name
HSHS GOOD SHEPHERD HOSPITAL INC
Doing business as
Shelby Memorial Hospital N H
Practice address
200 S Cedar St
Shelbyville, IL 62565-1838
Phone
(217) 774-3961
Fax
(217) 774-5713
NPI assigned
Jul 28, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Mark D Evard
Title
VP of Revenue Cycle
Phone
(217) 492-9651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0015677 IL Primary

Addresses

Primary practice location

200 S Cedar St
Shelbyville, IL 62565-1838

Mailing address

3051 Hollis Dr
Springfield, IL 62704-7450
Phone (217) 774-3961

Other names 1

  • SHELBY MEMORIAL HOSPITAL N H Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040327000037 IL Part B Supplier - Clinic/Group Practice 9335031061 Receives reassigned benefits from 25 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shelbyville, IL

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1376557983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 HOLLIS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047450",
            "telephone_number": "217-774-3961",
            "fax_number": "217-774-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S CEDAR ST",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625651838",
            "telephone_number": "217-774-3961",
            "fax_number": "217-774-5713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HSHS GOOD SHEPHERD HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "EVARD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "217-492-9651"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0015677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHELBY MEMORIAL HOSPITAL N H",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SHELBY MEMORIAL HOSPITAL N H",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelbyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.