NPIMap

Organization Active NPI

Hoopeston Community Memorial Hospital

Doing business as Carle Mattoon on Hurst

  • Rural Health Clinic/Center
  • Mattoon, IL
National Provider Identifier
1750785986
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Doing business as
Carle Mattoon on Hurst
Practice address
2512 Hurst Dr
Mattoon, IL 61938-9200
Phone
(217) 258-5900
NPI assigned
Oct 17, 2014
Last updated
Oct 17, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
THE CARLE FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Authorized official

Name
Mr. Harry Brockus
Title
Ceo
Phone
(217) 283-8540

Specialties & licenses 1

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

Addresses

Primary practice location

2512 Hurst Dr
Mattoon, IL 61938-9200

Mailing address

611 W Park St
Urbana, IL 61801-2500
Phone (217) 383-3311

Other names 1

  • CARLE MATTOON ON HURST Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141110000785 IL Part A Provider - Rural Health Clinic 3577456037 Practice locations: Mattoon, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750785986. Details of each certification follow.

Rural health clinic certification: CCN 148544

Legal name
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Doing business as
CARLE MATTOON ON HURST
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 21, 2015
Last certification
May 21, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 3, 1956 in IL
Enrollment address
2512 Hurst Dr
# 130
Mattoon, IL 61938-9200
Related CCNs
141316

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).

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
14D2085243Carle Mattoon on Hurst2512 Hurst Dr, Ste 130, Mattoon, IL 61938Provider-performed microscopyOct 8, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hoopeston Community11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Laura Williams Individual Corporate DirectorBoard Member Jan 1, 2022
Sally J Salmons Individual Corporate Director Jan 26, 2017
Allison Slocum Individual Corporate Director Jan 1, 2020
Karla J Coon Individual Corporate DirectorBoard Member Jan 1, 2021
William Nicholls Individual Corporate Director Jun 14, 2019
Heather Tucker Individual Corporate OfficerHospital Administrator Aug 14, 2020
Corporate DirectorHospital Administrator Aug 14, 2020
W-2 Managing EmployeeHospital Administrator Aug 14, 2020
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2014 100%
Larry Baughn Individual Corporate DirectorBoard Member Jan 1, 2022
James C Leonard Individual Other Nov 1, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1750785986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-3311",
            "fax_number": "217-367-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 HURST DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389200",
            "telephone_number": "217-258-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOOPESTON COMMUNITY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CARLE FOUNDATION",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "BROCKUS",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-283-8540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARLE MATTOON ON HURST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.