NPIMap

Organization Active NPI

Jersey Community Hospital

  • Rural Health Clinic/Center
  • Jerseyville, IL
National Provider Identifier
1700423696
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JERSEY COMMUNITY HOSPITAL
Practice address
903 S State St
Jerseyville, IL 62052-2344
Phone
(618) 639-9255
Fax
(618) 639-8000
NPI assigned
Dec 10, 2019
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Michelle Hopper
Title
Cfo
Phone
(618) 498-8349

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

903 S State St
Jerseyville, IL 62052-2344

Mailing address

PO Box 405
Jerseyville, IL 62052-0405
Phone (618) 498-8310

Other names 2

  • JCH Medical Group- Jerseyville IV Other name
  • JCH Medical Group-Jerseyville IV Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200430000029 IL Part A Provider - Rural Health Clinic 4587650445 Practice locations: Jerseyville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700423696. Details of each certification follow.

Rural health clinic certification: CCN 148610

Legal name
JERSEY COMMUNITY HOSPITAL
Doing business as
JCH MEDICAL GROUP-JERSEYVILLE IV
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 28, 2020
Last certification
May 28, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
903 S State St
Jerseyville, IL 62052-2344
Related CCNs
140059

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

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Jersey Community Hospit13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

103 McCausland St
Carlinville, IL 62626
Phone (217) 854-2623

1440 W Walnut St
Ste 2A
Jacksonville, IL 62650
Phone (217) 243-3543

101 N State St
Jerseyville, IL 62052
Phone 6184967516232

1702 W County Rd
Jerseyville, IL 62052
Phone (618) 498-1500

402 N Wood St
Staunton, IL 62088
Phone (618) 391-6495

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Michelle Hopper Individual Corporate OfficerCfo Mar 31, 2014
Dawn Stumpf Individual W-2 Managing EmployeeSurrogate/Access Manager Jan 1, 2015
Jersey Community Hospital Organization, Jerseyville, IL 5% Or Greater Direct Ownership Interest Mar 1, 2020 100%
Randy E Newberry Individual Corporate DirectorBoard Member Jan 28, 2010

Owners & managing parties with NPI records 10

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
Jersey Community HospitalJerseyville, IL, CCN 140059 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
JCH Medical Group - Jerseyville IIJerseyville, IL, CCN 148550 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
JCH Medical Group- Jerseyville IIIJerseyville, IL, CCN 148604 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2019

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 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1700423696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 405",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620520405",
            "telephone_number": "618-498-8310",
            "fax_number": "618-498-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 S STATE ST",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522344",
            "telephone_number": "618-639-9255",
            "fax_number": "618-639-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERSEY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-10",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "HOPPER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-498-8349"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCH Medical Group- Jerseyville IV",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "JCH Medical Group- Jerseyville IV",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "JCH Medical Group-Jerseyville IV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jerseyville, IL

Sources for this page

Verify at the official NPI Registry.