NPIMap

Organization Active NPI

Hamilton Memorial Hospital District

Doing business as Hamilton Memorial Family Clinic

  • Rural Health Clinic/Center
  • McLeansboro, IL
National Provider Identifier
1609837665
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
000085 Issued in IL
Legal business name
HAMILTON MEMORIAL HOSPITAL DISTRICT
Doing business as
Hamilton Memorial Family Clinic
Practice address
611 S Marshall Avenue
McLeansboro, IL 62859
Phone
(618) 643-2361
Fax
(618) 643-2875
NPI assigned
Mar 30, 2006
Last updated
Sep 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 000085 IL Primary

Addresses

Primary practice location

611 S Marshall Avenue
McLeansboro, IL 62859

Mailing address

611 S Marshall Ave
PO Box 429
MC Leansboro, IL 62859-1213
Phone (618) 643-2361

Other names 1

  • HAMILTON MEMORIAL 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
Practice locations: Carmi, IL; MC Leansboro, IL
O20070524000254 IL Part A Provider - Rural Health Clinic 6608865985 Practice locations: MC Leansboro, IL
O20140320000452 IL Part A Provider - Rural Health Clinic 6608865985 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carmi, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1609837665. Details of each certification follow.

Rural health clinic certification: CCN 143477

Legal name
HAMILTON MEMORIAL HOSPITAL DISTRICT
Doing business as
HAMILTON MEMORIAL FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 11, 2006
Last certification
Mar 12, 2025
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Oct 17, 1957 in IL
Enrollment address
611 S Marshall Ave
MC Leansboro, IL 62859-1213
Related CCNs
141326

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.

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
14D2107699Hamilton Memorial Family Clinic611 S Marshall Ave, MC Leansboro, IL 62859Certificate of waiverDec 4, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Carrie Ragan Individual Corporate DirectorBoard Member Jan 1, 2023
Kenny Aydt Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate DirectorBoard Member Jan 1, 2022
Greg Muehlenbein Individual Corporate Director Jul 10, 2008
Corporate DirectorMember of the Board of Directors Feb 1, 2013
Victoria L Woodrow Individual Corporate OfficerCeo Sep 27, 2017
W-2 Managing EmployeeCeo Sep 27, 2017
John Warner Individual Corporate DirectorBoard Member Jul 1, 2013
Corporate DirectorBoard Member Jan 1, 2022
Marilyn Cross Individual Corporate DirectorBoard Member Jan 1, 2023
Justin Epperson Individual Corporate OfficerCfo Jul 1, 2020
Corporate DirectorCfo Jul 1, 2020
W-2 Managing EmployeeCfo Jul 1, 2020
Jason Waier Individual Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2022
Wayne Morris Individual Corporate DirectorBoard Member Aug 31, 2011
Corporate DirectorMember of the Board of Directors Feb 1, 2013
Kelly Karcher Individual Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2022
Paula J Hatfield Individual Corporate DirectorMember of the Board of Directors Feb 1, 2013
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.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Hamilton Memorial Family ClinicCarmi, IL, CCN 148529 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2012

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 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1609837665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S MARSHALL AVE",
            "address_2": "PO BOX 429",
            "city": "MC LEANSBORO",
            "state": "IL",
            "postal_code": "628591213",
            "telephone_number": "618-643-2361",
            "fax_number": "618-643-2875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S MARSHALL AVENUE",
            "city": "MCLEANSBORO",
            "state": "IL",
            "postal_code": "62859",
            "telephone_number": "618-643-2361",
            "fax_number": "618-643-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMILTON MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-30",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "000085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAMILTON MEMORIAL FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McLeansboro, IL

Sources for this page

Verify at the official NPI Registry.