NPIMap

Organization Active NPI

Pinckneyville Community Hospital

  • Critical Access Hospital
  • Pinckneyville, IL
National Provider Identifier
1689646523
Registry record updated Jan 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0001891 Issued in IL
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
Feb 5, 2006
Last updated
Jan 26, 2016By the provider in NPPES
Organization subpart
No

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
Mrs. Kara Jo Carson
Title
Cfo
Phone
(618) 357-2187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0001891 IL 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 6

IdentifierTypeStateIssuer
277OtherILBCBS HOSPITAL ID
111948OtherILHEALTHLINK PROVIDER ID
7315810OtherILBCBS ER PHYS ID
003663OtherILHEALTH ALLIANCE HOSPITAL
CF1266OtherILMEDICARE RAILROAD
162116OtherILUNITED HEALTHCARE ID

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040131000065 IL Part B Supplier - Clinic/Group Practice 8123921632 Receives reassigned benefits from 47 practitioners
1 other NPI on this enrollment
Practice locations: Pinckneyville, IL
O20080506000051 IL Part A Provider - Critical Access Hospital 8123921632 Receives reassigned benefits from 57 practitioners
Practice locations: Pinckneyville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689646523. Details of each certification follow.

Hospital certification: CCN 141307

Legal name
PINCKNEYVILLE COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 6, 2001
Last certification
Nov 2, 2021
Beds
17
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Mar 15, 1951 in IL
Enrollment address
5383 State Route 154
Pinckneyville, IL 62274-3342
Other Hospital Practice Location

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).

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Pinckneyville Community HospitalCCN 141307 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

5383 State Route 154
Pinckneyville, IL 62274
Phone (618) 357-2131

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 EmployeeChief Financial Officer Mar 24, 2008
Pinckneyville Community Hospital Organization, Pinckneyville, IL Created for acquisition 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
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 14Z307 Hospital 5% Or Greater Direct Ownership Interest 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 64

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 64

Affiliated clinicians 91

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

View all 91

NPI Registry JSON

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

{
    "created_epoch": "1139097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1689646523",
    "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": "NO",
        "enumeration_date": "2006-02-05",
        "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": "CFO",
        "authorized_official_telephone_number": "618-357-2187",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0001891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPITAL ID",
            "identifier": "277",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PROVIDER ID",
            "identifier": "111948",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ER PHYS ID",
            "identifier": "7315810",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE HOSPITAL",
            "identifier": "003663",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CF1266",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE ID",
            "identifier": "162116",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinckneyville, IL

Sources for this page

Verify at the official NPI Registry.