Jersey Community Hospital
Organization Active NPI Rural Health Clinic/Center · Carrollton, IL
NPI 1689079642 · NPPES record last updated Mar 5, 2025
Key facts
- NPI
- 1689079642
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 0001156 (IL)
- Legal business name
- JERSEY COMMUNITY HOSPITAL
- Practice address
- 523 S Main St
Carrollton, IL 62016-1256 - Phone
- (217) 942-3326
- Fax
- (217) 942-9833
- NPI assigned
- Nov 3, 2014
- Organization subpart
- Yes
- Parent organization (as reported)
- JERSEY COMMUNITY HOSPITAL
Authorized official
- Name
- Michelle Hopper
- Title
- Cfo
- Phone
- (618) 498-8349
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 12
Related certifications (CCN) 1
Practitioners 62
-
Olivia Arnett, APRN
-
Youssef Nmi Abdulnabi, M.D.
-
Jon E Andersen, DO
-
Jacqueline Sue Baalman, FNP-BC
-
Tammie L Blevins, ANP
-
Natasha Cheek, CRNA
-
Lester A Crancer, DO
-
Christopher Cruz, MD
-
Emily Ann Dix, CRNA
-
Leoncio S Dizon, MD
-
Daniel Andreas Elke, M.D
-
Alexandra Irene Evans, FNP-BC
-
Carie A Evans, WHNP-BC
-
Victoria A Hargrave, FNP-BC
-
Erinn E Hileman, APN
-
Tim C Kisabeth, MD
-
Kevin G. Koth, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0950288 | JCH Medical Group | Certificate of waiver | Mar 7, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Rural health clinic certification: CCN 148537
- Legal name
- JERSEY COMMUNITY HOSPITAL
- Doing business as
- JCH MEDICAL GROUP-CARROLLTON
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 1, 2015
- Last certification
- Feb 14, 2019
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 523 S Main St
Carrollton, IL 62016-1256 - Related CCNs
- 140059
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Ben Poletti |
Corporate Director |
Oct 29, 2020 | |
| William H Strang |
Corporate Director |
Jan 1, 2015 | |
| Michelle Hopper |
Corporate Officer |
Mar 31, 2014 | |
| Dawn Stumpf |
W-2 Managing Employee |
Jan 1, 2015 | |
| Edward Goetten |
Corporate Director |
Mar 28, 2024 | |
| Mary E Kirbach |
Corporate Director |
Jan 1, 2015 | |
| Therese Macias |
Corporate Director |
May 16, 2016 | |
| Zachary Crawford |
Corporate Director |
Jan 14, 2016 | |
| Randy E Newberry |
Corporate Director |
Jan 1, 2015 | |
| Dean P Heneghan |
Corporate Director |
Jan 1, 2015 | |
| Joe J Soer |
Corporate Director |
Jan 1, 2015 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Jersey Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1966 |
| JCH Medical Group - Jerseyville II |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| JCH Medical Group- Jerseyville III |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2019 |
| JCH Medical Group-Jerseyville IV |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141210001510 | IL | Part a Provider - Rural Health Clinic | 4587650445 | Practice locations: Carrollton, IL |
National Provider Directory
- Tax ID family
- Jersey Community Hospital District
- Part of
- Jersey Community Hospital District
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 0001156 | IL | Yes |
Addresses
Primary practice location
523 S Main St
Carrollton, IL 62016-1256
Mailing address
390 Maple Summit Rd
Jerseyville, IL 62052-2000
Phone (618) 498-7518
Other names
- JCH Medical Group - Carrollton
- JCH Medical Group-Carrollton
Other providers in Carrollton, IL
- Ken Gray
- Greene County Ambulance
- Hamel Chiropractic Clinic LLC
- Justin Kyle Hamel
- Lisa A Hart
- Jose P Parcon M D S C
- Lauren Lippert
- Kristen Liston
- Longnecker Optometry LLC
- Renan R Mapue
All providers in Carrollton, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.