NPIMap

Organization Active NPI

Salem Township Hospital

Doing business as STH Family Health Care Center

  • Rural Health Clinic/Center
  • Salem, IL
National Provider Identifier
1649830472
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SALEM TOWNSHIP HOSPITAL
Doing business as
STH Family Health Care Center
Salem Township Hospital Family Healthcare Center
Practice address
1321 W Whittaker St
Salem, IL 62881-2013
Phone
(618) 548-6644
Fax
(844) 659-5619
NPI assigned
Jun 14, 2019
Last updated
Aug 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SALEM TOWNSHIP HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Authorized official

Name
Mr. James Timpe
Title
President/Ceo/Cfo
Phone
(618) 548-3194

Specialties & licenses 1

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

Addresses

Primary practice location

1321 W Whittaker St
Salem, IL 62881-2013

Mailing address

1201 Ricker Rd
Salem, IL 62881-4263
Phone (618) 548-3194

Other names 2

  • STH Family Health Care Center Doing business as
  • Salem Township Hospital Family Healthcare Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031126000688 IL Part B Supplier - Clinic/Group Practice 0840195277 Receives reassigned benefits from 42 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, IL
O20190702001978 IL Part A Provider - Rural Health Clinic 0840195277 Practice locations: Salem, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649830472. Details of each certification follow.

Rural health clinic certification: CCN 148608

Legal name
SALEM TOWNSHIP HOSPITAL
Doing business as
STH FAMILY HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 30, 2020
Last certification
Jan 30, 2020
Ownership / control type
2B
Organization structure
GovernmentProprietary
Incorporated
May 1, 1942 in IL
Enrollment address
1321 W Whittaker St
Salem, IL 62881-2013
Related CCNs
141345

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 6

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

National Provider Directory

National Provider Directory
Tax ID family
Public Hosp of Salem6 organizations share this tax ID, including this one
Part of
Public Hosp of Salem

Other organizations with this tax ID 5

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

Locations

1321 W Whittaker St
Salem, IL 62881
Phone (618) 548-0200

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
Salem Township Hospital Organization, Salem, IL Medical provider/supplier 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Michael L Morton Individual Corporate DirectorBoard Member Feb 1, 2010
Todd Woodruff Individual Corporate DirectorBoard Member Aug 1, 2015
Mark Clark Individual Corporate DirectorBoard Member Jun 17, 2019
Sandra Phillips Individual Corporate DirectorBoard Member Jan 1, 2013
Amy Marsh Individual Corporate OfficerChief Financial Officer Dec 5, 2023
W-2 Managing EmployeeAd; Dec 5, 2023

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 3

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

FacilityTypeRoleSince
Salem Township HospitalSalem, IL, CCN 141345 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2005
Salem Township HospitalSalem, IL, CCN 14Z345 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2005
Salem Township Hospital Rural Health ClinicSalem, IL, CCN 143413 Rural health clinic Operational/Managerial Control Jul 1, 2018

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1649830472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 RICKER RD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628814263",
            "telephone_number": "618-548-3194",
            "fax_number": "618-548-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 W WHITTAKER ST",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628812013",
            "telephone_number": "618-548-6644",
            "fax_number": "844-659-5619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM TOWNSHIP HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SALEM TOWNSHIP HOSPITAL",
        "enumeration_date": "2019-06-14",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "TIMPE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "618-548-3194",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STH Family Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Salem Township Hospital Family Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, IL

Sources for this page

Verify at the official NPI Registry.