NPIMap

Organization Active NPI

Thomas H. Boyd Memorial Hospital

  • Skilled Nursing Facility
  • Carrollton, IL
National Provider Identifier
1699973685
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0002782 Issued in IL
Legal business name
THOMAS H. BOYD MEMORIAL HOSPITAL
Practice address
800 School St
Carrollton, IL 62016-1436
Phone
(217) 942-9410
Fax
(217) 942-6091
NPI assigned
Jul 11, 2007
Last updated
Apr 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Stace Holland
Title
Ceo
Phone
(217) 942-6946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0002782 IL Primary

Addresses

Primary practice location

800 School St
Carrollton, IL 62016-1436

Mailing address

800 School St
Carrollton, IL 62016-1436
Phone (217) 942-9410

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110118000988 IL Part A Provider - Critical Access Hospital 8123085560 1 other NPI on this enrollment
Practice locations: Carrollton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699973685. Details of each certification follow.

Hospital certification: CCN 14Z300

Legal name
THOMAS H BOYD MEMORIAL HOSPITAL
Doing business as
BOYD HEALTHCARE SERVICES
Organization structure
CorporationNon-profit
Enrollment address
800 School St
Carrollton, IL 62016-1436

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

Other NPIs with the same Medicare PAC ID 5

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.

National Provider Directory

National Provider Directory
Tax ID family
Boyd Mem Hosp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jenny Clough Individual Corporate Director Jul 1, 2022
Raymond Beavers Individual Corporate DirectorBoard of Trustees Feb 1, 2016
Kathryn Garner Individual Corporate OfficerCfo Jan 13, 2023
W-2 Managing EmployeeCfo Jan 13, 2023
Operational/Managerial ControlCfo Jan 13, 2023
Mary Tunison Individual Corporate DirectorBoard of Trustees Jun 17, 2002
Diane Wolfley Individual Corporate DirectorBoard of Trustees Dec 1, 2004
Stacy D Holland Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Operational/Managerial ControlCeo Apr 22, 2024
Mary Plummer Individual Corporate DirectorBoard of Trustees Dec 1, 2018
Kirby Ballard Individual Corporate DirectorBoard of Trustees Sep 25, 2017

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Greene County Rural Health ClinicCarrollton, IL, CCN 143403 Rural health clinic Operational/Managerial Control Jun 21, 2010

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

Affiliated clinicians 5

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": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1699973685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SCHOOL ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161436",
            "telephone_number": "217-942-9410",
            "fax_number": "217-942-6091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCHOOL ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161436",
            "telephone_number": "217-942-9410",
            "fax_number": "217-942-6091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS H. BOYD MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "STACE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-942-6946"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0002782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, IL

Sources for this page

Verify at the official NPI Registry.