NPIMap

Organization Active NPI

Jersey Community Hospital

  • Rural Health Clinic/Center
  • Roodhouse, IL
National Provider Identifier
1770988735
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0001156 Issued in IL
Legal business name
JERSEY COMMUNITY HOSPITAL
Practice address
414 S State St
Roodhouse, IL 62082-1544
Phone
(217) 589-4383
Fax
(217) 589-4409
NPI assigned
Nov 3, 2014
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
JERSEY COMMUNITY HOSPITALAs reported in NPPES

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0001156 IL Primary

Addresses

Primary practice location

414 S State St
Roodhouse, IL 62082-1544

Mailing address

390 Maple Summit Rd
Jerseyville, IL 62052-2000
Phone (618) 498-7518

Other practice location 1

205 S Morse St
Roodhouse, IL 62082-1322
Phone (217) 589-4383

Other names 1

  • JCH Medical Group-Roodhouse Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141210001995 IL Part A Provider - Rural Health Clinic 4587650445 Practice locations: Roodhouse, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770988735. Details of each certification follow.

Rural health clinic certification: CCN 148540

Legal name
JERSEY COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2015
Last certification
Nov 11, 2016
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
414 S State St
Roodhouse, IL 62082-1544
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).

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
14D0433754JCH Medical Group414 S State St, Roodhouse, IL 62082Provider-performed microscopyFeb 4, 2028

National Provider Directory

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

Other organizations with this tax ID 12

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

Locations

390 Maple Summit Rd
Jerseyville, IL 62052
Phone (618) 498-2101

205 S Morse St
Roodhouse, IL 62082
Phone (217) 589-4383

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Ben Poletti Individual Corporate DirectorBoard Member Oct 29, 2020
William H Strang Individual Corporate DirectorBoard Member Jan 1, 2015
Michelle Hopper Individual Corporate OfficerCfo Mar 31, 2014
Dawn Stumpf Individual W-2 Managing EmployeeSurrogate/Access Manager Jan 1, 2015
Edward Goetten Individual Corporate DirectorBoard Member Mar 28, 2024
Mary E Kirbach Individual Corporate DirectorBoard Member Jan 1, 2015
Therese Macias Individual Corporate DirectorBoard Member May 16, 2016
Zachary Crawford Individual Corporate DirectorBoard Member Jan 14, 2016
Randy E Newberry Individual Corporate DirectorBoard Member Jan 1, 2015
Dean P Heneghan Individual Corporate DirectorBoard Member Jan 1, 2015
Joe J Soer Individual Corporate DirectorBoard Member Jan 1, 2015

All facility ownership & control disclosures 4

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
JCH Medical Group-Jerseyville IVJerseyville, IL, CCN 148610 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2020

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1414972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1770988735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 MAPLE SUMMIT RD",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522000",
            "telephone_number": "618-498-7518",
            "fax_number": "618-498-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 S STATE ST",
            "city": "ROODHOUSE",
            "state": "IL",
            "postal_code": "620821544",
            "telephone_number": "217-589-4383",
            "fax_number": "217-589-4409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 S Morse St",
            "address_purpose": "LOCATION",
            "city": "Roodhouse",
            "state": "IL",
            "postal_code": "620821322",
            "country_code": "US",
            "telephone_number": "217-589-4383",
            "fax_number": "217-589-4409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JERSEY COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JERSEY COMMUNITY HOSPITAL",
        "enumeration_date": "2014-11-03",
        "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": "IL",
            "license": "0001156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCH Medical Group-Roodhouse",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "JCH Medical Group-Roodhouse",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roodhouse, IL

Sources for this page

Verify at the official NPI Registry.