NPIMap

Organization Active NPI

Hoopeston Community Memorial Hospital

Doing business as Carle at Watseka

  • Rural Health Clinic/Center
  • Watseka, IL
National Provider Identifier
1467549402
Registry record updated May 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0004200 Issued in IL
Legal business name
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Doing business as
Carle at Watseka
Practice address
1490 E Walnut St
Suite C
Watseka, IL 60970-1806
Phone
(815) 432-8200
Fax
(815) 432-8201
NPI assigned
Oct 10, 2006
Last updated
May 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2016

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

Authorized official

Name
Mr. Harry Brockus
Title
Ceo
Phone
(217) 283-8540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0004200 IL Primary

Addresses

Primary practice location

1490 E Walnut St
Suite C
Watseka, IL 60970-1806

Mailing address

611 W. Park St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792

Other identifiers 1

IdentifierTypeStateIssuer
210046OtherILWPS

Other names 1

  • Carle at Watseka Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120814000494 IL Part A Provider - Rural Health Clinic 3577456037 Practice locations: Watseka, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467549402. Details of each certification follow.

Rural health clinic certification: CCN 148521

Legal name
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Doing business as
CARLE WATSEKA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 4, 2012
Last certification
Jan 23, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 1956 in IL
Enrollment address
1490 E Walnut St
Ste C
Watseka, IL 60970-1806
Related CCNs
141316

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

Other NPIs with the same Medicare PAC ID 10

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

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
14D0429512Carle Watseka Clinic1490 East Walnut, Watseka, IL 60970Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hoopeston Medical Cente11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Laura Williams Individual Corporate DirectorBoard Member Jan 1, 2022
Sally J Salmons Individual Corporate Director Jan 26, 2017
Allison Slocum Individual Corporate Director Jan 1, 2020
Karla J Coon Individual Corporate DirectorBoard Member Jan 1, 2021
William Nicholls Individual Corporate Director Jun 14, 2019
Heather Tucker Individual Corporate OfficerHospital Administrator Aug 14, 2020
Corporate DirectorHospital Administrator Aug 14, 2020
W-2 Managing EmployeeHospital Administrator Aug 14, 2020
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2012 100%
Larry Baughn Individual Corporate DirectorBoard Member Jan 1, 2022
James C Leonard Individual Other Nov 1, 2012

Owners & managing parties with NPI records 1

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 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1467549402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-6792",
            "fax_number": "217-383-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E WALNUT ST",
            "address_2": "SUITE C",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701806",
            "telephone_number": "815-432-8200",
            "fax_number": "815-432-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOOPESTON COMMUNITY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "BROCKUS",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-283-8540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0004200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WPS",
            "identifier": "210046",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carle at Watseka",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watseka, IL

Sources for this page

Verify at the official NPI Registry.