NPIMap

Organization Active NPI

Macoupin County Public Health Department

  • Public Health or Welfare Agency
  • Gillespie, IL
National Provider Identifier
1750814349
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
240000117 Issued in IL
Legal business name
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Practice address
109 E Maple St
Gillespie, IL 62033-1473
Phone
(217) 839-4104
Fax
(217) 839-4160
NPI assigned
Apr 10, 2017
Last updated
Mar 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Christy Blank
Title
Ceo
Phone
(217) 930-2283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 240000117 IL Primary

Addresses

Primary practice location

109 E Maple St
Gillespie, IL 62033-1473

Mailing address

205 Oakland Ave
Carlinville, IL 62626-1921
Phone (217) 839-7820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20060223000446 IL Part B Supplier - Clinic/Group Practice 1557377850 Receives reassigned benefits from 21 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carlinville, IL; Gillespie, IL; Litchfield, IL
O20120221000973 IL Part A Provider - Federally Qualified Health Center (FQHC) 1557377850 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gillespie, IL
O20191105001065 IL Part B Supplier - Clinic/Group Practice 1557377850 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carlinville, IL; Gillespie, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750814349. Details of each certification follow.

Federally qualified health center certification: CCN 141154

Legal name
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 21, 2012
Last certification
Feb 21, 2012
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Oct 20, 2010 in IL
Enrollment address
109 E Maple St
Ste 1
Gillespie, IL 62033-1474

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

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
Christy Blank Individual Corporate DirectorCeo Jan 15, 2023
W-2 Managing EmployeeCeo Jan 15, 2023
Operational/Managerial ControlCeo Jan 15, 2023
Macoupin County Public Health Department Organization, Carlinville, IL 5% Or Greater Direct Ownership Interest Oct 20, 2010 100%
Lori Sanson Individual W-2 Managing EmployeeCfo Dec 1, 2022
Operational/Managerial ControlCfo Dec 1, 2022

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1750814349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 OAKLAND AVE",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261921",
            "telephone_number": "217-839-7820",
            "fax_number": "217-839-1538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E MAPLE ST",
            "city": "GILLESPIE",
            "state": "IL",
            "postal_code": "620331473",
            "telephone_number": "217-839-4104",
            "fax_number": "217-839-4160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-930-2283"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "IL",
            "license": "240000117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillespie, IL

Sources for this page

Verify at the official NPI Registry.