NPIMap

Organization Active NPI

St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

Doing business as Clinton County Rural Health Carlyle

  • Rural Health Clinic/Center
  • Carlyle, IL
National Provider Identifier
1710375977
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE
Doing business as
Clinton County Rural Health Carlyle
Practice address
14509 State Route 127
Carlyle, IL 62231-6485
Phone
(618) 594-8924
Fax
(618) 594-7918
NPI assigned
Dec 22, 2014
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Mark Duane Evard
Title
VP of Revenue Cycle
Phone
(217) 492-9651

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

14509 State Route 127
Carlyle, IL 62231-6485

Mailing address

3051 Hollis Dr
Springfield, IL 62704-7450
Phone (618) 594-8924

Other names 1

  • Clinton County Rural Health Carlyle Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address st_josephs_breeze_toc2203120@ewd.direct.hshs.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040217000493 IL Part B Supplier - Clinic/Group Practice 9638064892 Receives reassigned benefits from 57 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Breese, IL; Carlyle, IL

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0434208Clinton County Rural Health Carlyle14509 State Route 127, Carlyle, IL 62231Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

14509 State Route 127
Carlyle, IL 62231
Phone (618) 594-3613

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1710375977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 HOLLIS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047450",
            "telephone_number": "618-594-8924",
            "fax_number": "618-594-7918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14509 STATE ROUTE 127",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622316485",
            "telephone_number": "618-594-8924",
            "fax_number": "618-594-7918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-22",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "EVARD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "217-492-9651"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "st_josephs_breeze_toc2203120@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "9515 Holy Cross Ln",
            "city": "Breese",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622303618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Clinton County Rural Health Carlyle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinton County Rural Health Carlyle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carlyle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.