NPIMap

Organization Active NPI

Hamilton Memorial Hospital District

Doing business as Carmi Family Clinic

  • Rural Health Clinic/Center
  • Carmi, IL
National Provider Identifier
1588902183
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HAMILTON MEMORIAL HOSPITAL DISTRICT
Doing business as
Carmi Family Clinic
Practice address
1112 Oak St
Ste 102
Carmi, IL 62821-1344
Phone
(618) 382-5030
Fax
(855) 827-3536
NPI assigned
Jan 17, 2013
Last updated
Aug 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
HAMILTON MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Authorized official

Name
Justin Epperson
Title
Cfo
Phone
(618) 643-2361

Specialties & licenses 1

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

Addresses

Primary practice location

1112 Oak St
Ste 102
Carmi, IL 62821-1344

Mailing address

PO Box 429
MC Leansboro, IL 62859-0429
Phone (618) 643-2361

Other names 1

  • Carmi Family Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040511001018 IL Part B Supplier - Clinic/Group Practice 6608865985 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carmi, IL; MC Leansboro, IL
O20070524000235 IL Part A Provider - Critical Access Hospital 6608865985 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carmi, IL; McLeansboro, IL
O20140320000452 IL Part A Provider - Rural Health Clinic 6608865985 1 other NPI on this enrollment
Practice locations: Carmi, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1588902183. Details of each certification follow.

Hospital certification: CCN 141326

Legal name
HAMILTON MEMORIAL HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2003
Last certification
Jul 15, 2025
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
611S Marshall Ave
McLeansboro, IL 62859-1213
Other Hospital Practice Location

Rural health clinic certification: CCN 148529

Legal name
HAMILTON MEMORIAL HOSPITAL DISTRICT
Doing business as
HAMILTON MEMORIAL FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 6, 2013
Last certification
Jul 1, 2021
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
May 6, 2013 in IL
Enrollment address
1112 Oak St
# 102
Carmi, IL 62821-1344
Related CCNs
141326

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Hamilton Memorial HospitalCCN 141326 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
14D2077671Carmi Family Clinic1112 Oak St, Ste 103, Carmi, IL 62821Certificate of waiverNov 25, 2027

National Provider Directory

National Provider Directory
Part of
Walt W Mutschler MD

Locations

1112 Oak St
#102
Carmi, IL 62821
Phone (618) 382-5030

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
Kenny Aydt Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2022
Greg Muehlenbein Individual Corporate Director Jul 10, 2008 10%
Corporate DirectorMember of the Board of Directors Feb 1, 2013
John Warner Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2022
Marilyn Cross Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Paula J Hatfield Individual Corporate Director Jul 31, 2011 10%
Corporate DirectorMember of the Board of Directors Feb 1, 2013
Justin Epperson Individual Corporate OfficerCfo Jul 1, 2020
Corporate DirectorCfo Jul 1, 2020
W-2 Managing EmployeeCfo Jul 1, 2020
Jason Waier Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2022
Wayne Morris Individual Corporate Director Aug 31, 2011 10%
Corporate DirectorMember of the Board of Directors Feb 1, 2013
Kelly Karcher Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2022
James Johnson Individual Corporate DirectorBoard Member Jan 1, 2022
Hamilton Memorial Hospital District Organization, MC Leansboro, IL 5% Or Greater Direct Ownership Interest Feb 1, 2012 100%

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

Affiliated clinicians 72

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754006400000",
    "number": "1588902183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "city": "MC LEANSBORO",
            "state": "IL",
            "postal_code": "628590429",
            "telephone_number": "618-643-2361",
            "fax_number": "618-643-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 OAK ST",
            "address_2": "STE 102",
            "city": "CARMI",
            "state": "IL",
            "postal_code": "628211344",
            "telephone_number": "618-382-5030",
            "fax_number": "855-827-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMILTON MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAMILTON MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2013-01-17",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A",
        "authorized_official_last_name": "EPPERSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-643-2361"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carmi Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carmi, IL

Sources for this page

Verify at the official NPI Registry.