NPIMap

Organization Active NPI

Jersey Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Jerseyville, IL
National Provider Identifier
1508882630
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
0001156 Issued in IL
Legal business name
JERSEY COMMUNITY HOSPITAL
Practice address
400 Maple Summit Rd
Jerseyville, IL 62052-2028
Phone
(618) 498-6402
NPI assigned
Jul 14, 2006
Last updated
Mar 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Authorized official

Name
Beth King
Title
Ceo
Phone
(618) 498-6402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 0001156 IL Primary

Addresses

Primary practice location

400 Maple Summit Rd
Jerseyville, IL 62052-2028

Mailing address

400 Maple Summit Rd
Jerseyville, IL 62052-2028

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071127000129 IL Part A Provider - Hospital 4587650445 Practice locations: Jerseyville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508882630. Details of each certification follow.

Hospital certification: CCN 14U059

Legal name
JERSEY COMMUNITY HOSPITAL
Organization structure
GovernmentNon-profit
Enrollment address
400 Maple Summit Rd
Jerseyville, IL 62052-2028
Other Hospital Practice Location
Hospital subgroups
Swing-bed approved

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).

National Provider Directory

National Provider Directory
Tax ID family
Jersey Community Hospital District13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Ben Poletti Individual Corporate DirectorBoard Member Oct 29, 2020
William H Strang Individual Corporate DirectorBoard Member Apr 14, 1986
Michelle Hopper Individual Corporate OfficerCfo Mar 31, 2014
Dawn Stumpf Individual W-2 Managing EmployeeSurrogate/Access Manager Jan 1, 2015
Edward Goetten Individual Corporate DirectorBoard Member Mar 28, 2024
Mary E Kirbach Individual Corporate DirectorBoard Member Jun 30, 2005
Therese Macias Individual Corporate DirectorBoard Member May 16, 2016
Zachary Crawford Individual Corporate DirectorBoard Member Jan 14, 2016
Randy E Newberry Individual Corporate DirectorBoard Member Jan 28, 2010
Dean P Heneghan Individual Corporate DirectorBoard Member Jul 8, 2013
Joe J Soer Individual Corporate DirectorBoard Member Jun 14, 2011

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jersey Community HospitalJerseyville, IL, CCN 140059 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
JCH Medical Group - Jerseyville IIJerseyville, IL, CCN 148550 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
JCH Medical Group- Jerseyville IIIJerseyville, IL, CCN 148604 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2019
JCH Medical Group-Jerseyville IVJerseyville, IL, CCN 148610 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1508882630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MAPLE SUMMIT RD",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MAPLE SUMMIT RD",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522028",
            "telephone_number": "618-498-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERSEY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-498-6402"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IL",
            "license": "0001156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jerseyville, IL

Sources for this page

Verify at the official NPI Registry.