NPIMap

Organization Active NPI

Family Care Associates of Effingham, S.C.

  • Rural Health Clinic/Center
  • Effingham, IL
National Provider Identifier
1649255266
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0420007457 Issued in IL
Legal business name
FAMILY CARE ASSOCIATES OF EFFINGHAM, S.C.
Practice address
1106 N Merchant St
Effingham, IL 62401-2128
Phone
(217) 342-7000
NPI assigned
Dec 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Authorized official

Name
Thomas Heischmidt, M.D.NPI 1396720983
Title
President
Phone
(217) 342-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 042007457 IL
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 042007457 IL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 042007457 IL
Rural Health Clinic/Center 261QR1300X 0420007457 IL Primary

Addresses

Primary practice location

1106 N Merchant St
Effingham, IL 62401-2128

Mailing address

PO Box 665
Effingham, IL 62401-0665
Phone (217) 342-7000

Other identifiers 2

IdentifierTypeStateIssuer
CC5658OtherILM/C R.R. PROVIDER GROUP #
2521179OtherILBC/BS PROVIDER GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040414001058 IL Part B Supplier - Clinic/Group Practice 5890789416 Receives reassigned benefits from 20 practitioners
Practice locations: Effingham, IL
O20100211000078 IL Part A Provider - Rural Health Clinic 5890789416 Practice locations: Effingham, IL

Rural health clinic certification: CCN 783815

Legal name
FAMILY CARE ASSOCIATES OF EFFINGHAM SC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 14, 2010
Last certification
Jul 17, 2024
Ownership / control type
2B
Organization structure
CorporationProprietary
Incorporated
Dec 21, 1995 in IL
Enrollment address
1106N Merchant St
Effingham, IL 62401-2128

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
14D0682332Family Care Associates of Effingham SC1106 N Merchant PO Box 665, Effingham, IL 62401Provider-performed microscopyMar 10, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Jeffrey K Brummer Individual 5% Or Greater Direct Ownership Interest Dec 7, 2009 16%
Corporate Director Dec 7, 2009 16%
W-2 Managing Employee Dec 7, 2009 16%
Jeffrey G Crowell Individual 5% Or Greater Direct Ownership Interest Dec 7, 2009 17%
Corporate Director Dec 7, 2009 17%
W-2 Managing Employee Dec 7, 2009 17%
Michael G Brummer Individual 5% Or Greater Direct Ownership Interest Dec 7, 2009 17%
Corporate Director Dec 7, 2009 17%
W-2 Managing Employee Dec 7, 2009 17%
Mary Colleen Bingham Individual 5% Or Greater Direct Ownership Interest Dec 7, 2009 17%
Corporate Director Dec 7, 2009 17%
W-2 Managing Employee Dec 7, 2009 17%
Amanda Lea Bierman Individual 5% Or Greater Direct Ownership Interest Oct 1, 2012 16%
Corporate Director Oct 1, 2012 16%
W-2 Managing Employee Oct 1, 2012 16%
Thomas a Heischmidt Individual 5% Or Greater Direct Ownership Interest Dec 7, 2009 17%
Corporate Director Dec 7, 2009 17%
W-2 Managing Employee Dec 7, 2009 17%

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1649255266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 665",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624010665",
            "telephone_number": "217-342-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 N MERCHANT ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012128",
            "telephone_number": "217-342-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE ASSOCIATES OF EFFINGHAM, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "HEISCHMIDT",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-342-7000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "042007457",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "042007457",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "042007457",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0420007457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M/C R.R. PROVIDER GROUP #",
            "identifier": "CC5658",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER GROUP #",
            "identifier": "2521179",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.