NPIMap

Organization Active NPI

Julia Rackley Perry Memorial Hospital

Doing business as Perry Memorial Orthopedic & Sports Medicine

  • Multi-Specialty Clinic/Center
  • Princeton, IL
National Provider Identifier
1407028780
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Doing business as
Perry Memorial Orthopedic & Sports Medicine
Perry Memorial Podiatry Clinic
Practice address
530 Park Ave E Ste 306
Princeton, IL 61356-3903
Phone
(815) 876-3033
Fax
(815) 876-3003
NPI assigned
Mar 27, 2008
Last updated
Apr 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
JULIA RACKLEY PERRY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Jean Welte
Title
Medical Staff Services Coordinator
Phone
(815) 876-2293

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

530 Park Ave E Ste 306
Princeton, IL 61356-3903

Mailing address

530 Park Ave E
Princeton, IL 61356-3901
Phone (815) 875-2811

Other practice location 1

530 Park Ave E Ste 202
Princeton, IL 61356-3902
Phone (815) 872-3034

Other identifiers 1

IdentifierTypeStateIssuer
1407028780MedicaidIL

Other names 2

  • Perry Memorial Orthopedic & Sports Medicine Doing business as
  • Perry Memorial Podiatry Clinic Doing business as

National Provider Directory

National Provider Directory
Part of
Julia Rackley Perry Memorial Hospital

Locations

530 Park Ave E
Ste 306
Princeton, IL 61356
Phone (815) 875-4531

NPI Registry JSON

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1407028780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-875-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E STE 306",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563903",
            "telephone_number": "815-876-3033",
            "fax_number": "815-876-3003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 Park Ave E Ste 202",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IL",
            "postal_code": "613563902",
            "country_code": "US",
            "telephone_number": "815-872-3034",
            "fax_number": "815-872-3019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JULIA RACKLEY PERRY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JULIA RACKLEY PERRY MEMORIAL HOSPITAL",
        "enumeration_date": "2008-03-27",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "WELTE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "MEDICAL STAFF SERVICES COORDINATOR",
        "authorized_official_telephone_number": "815-876-2293"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407028780",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perry Memorial Orthopedic & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perry Memorial Podiatry Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.