NPIMap

Organization Active NPI

Pinckneyville Community Hospital

  • Critical Access Hospital
  • Pinckneyville, IL
National Provider Identifier
1629039706
Registry record updated Jan 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
PINCKNEYVILLE COMMUNITY HOSPITAL
Practice address
5383 State Route 154
Pinckneyville, IL 62274-3342
Phone
(618) 357-2187
Fax
(618) 357-8888
NPI assigned
Mar 29, 2006
Last updated
Jan 26, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PINCKNEYVILLE COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2016

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

Authorized official

Name
Kara Jo Carson, MACC, CPA, CHFP
Title
Chief Financial Officer
Phone
(618) 357-5902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

5383 State Route 154
Pinckneyville, IL 62274-3342

Mailing address

5383 State Route 154
Pinckneyville, IL 62274-3342
Phone (618) 357-2187

Other identifiers 3

IdentifierTypeStateIssuer
162116OtherILUNITED HEALTHCARE ID
111948OtherILHEALTHLINK PROVIDER ID
003663OtherILHEALTH ALLIANCE HOSPITAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080506000076 IL Part A Provider - Critical Access Hospital 8123921632 Receives reassigned benefits from 1 practitioner
Practice locations: Pinckneyville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629039706. Details of each certification follow.

Hospital certification: CCN 14Z307

Legal name
PINCKNEYVILLE COMMUNITY HOSPITAL
Organization structure
GovernmentNon-profit
Incorporated
Mar 15, 1951 in IL
Enrollment address
5383 State Route 154
Pinckneyville, IL 62274-3342

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Pinckneyville Comm Hosp15 organizations share this tax ID, including this one
Part of
Pinckneyville Comm Hosp

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Kara Carson Individual W-2 Managing Employee Mar 24, 2008
Pinckneyville Community Hospital Organization, Pinckneyville, IL 5% Or Greater Direct Ownership Interest Jan 1, 1966
Randall W Dauby Individual Corporate OfficerCeo Jul 15, 2015

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Pinckneyville Community HospitalPinckneyville, IL, CCN 141307 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Family Medical CenterPinckneyville, IL, CCN 143412 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1629039706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5383 STATE ROUTE 154",
            "city": "PINCKNEYVILLE",
            "state": "IL",
            "postal_code": "622743342",
            "telephone_number": "618-357-2187",
            "fax_number": "618-357-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5383 STATE ROUTE 154",
            "city": "PINCKNEYVILLE",
            "state": "IL",
            "postal_code": "622743342",
            "telephone_number": "618-357-2187",
            "fax_number": "618-357-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINCKNEYVILLE COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINCKNEYVILLE COMMUNITY HOSPITAL",
        "enumeration_date": "2006-03-29",
        "last_updated": "2016-01-26",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "KARA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "618-357-5902",
        "authorized_official_credential": "MACC, CPA, CHFP"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE ID",
            "identifier": "162116",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PROVIDER ID",
            "identifier": "111948",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE HOSPITAL",
            "identifier": "003663",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinckneyville, IL

Sources for this page

Verify at the official NPI Registry.