NPIMap

Organization Active NPI

Richland Memorial Hospital, Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Olney, IL
National Provider Identifier
1821032525
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
RICHLAND MEMORIAL HOSPITAL, INC
Practice address
800 E Locust St
Olney, IL 62450-2553
Phone
(618) 395-7340
NPI assigned
Jun 15, 2006
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Harry Brockus
Title
Ceo
Phone
(618) 395-7340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

800 E Locust St
Olney, IL 62450-2553

Mailing address

800 E Locust St
Olney, IL 62450-2553

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240816000207 IL Part A Provider - Critical Access Hospital 3870565732 1 other NPI on this enrollment
Practice locations: Olney, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821032525. Details of each certification follow.

Hospital certification: CCN 14Z355

Legal name
RICHLAND MEMORIAL HOSPITAL INC
Doing business as
CARLE RICHLAND MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Sep 30, 1996 in IL
Enrollment address
800 E Locust St
Olney, IL 62450-2553
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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 15

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

NameRoleSinceShare
Brian L Atwood Individual Corporate DirectorBoard Member Jan 1, 2019
Steven T Thomson Individual Corporate DirectorBoard Member Oct 1, 2022
Larry D Dunn Individual Corporate DirectorBoard Member Oct 26, 2021
Tanner M Miller Individual Corporate DirectorBoard Member Jan 1, 2022
Raymond L Fisher Individual Corporate DirectorBoard Member Oct 1, 2020
Sherry L Geier Individual Corporate DirectorBoard Member Oct 26, 2021
Bernard Eugene Brauer Individual Corporate DirectorBoard Member Oct 1, 2022
Regina Rachel Thomas Individual Corporate OfficerPresident Mar 4, 2021
W-2 Managing EmployeePresident Mar 4, 2021
Jennifer Cummins-Zuber Individual Corporate DirectorBoard Member Oct 23, 2018
Gary Houchin Individual Corporate DirectorBoard Member Oct 23, 2018
Patricia Lynn Kessler-Bookhout Individual Corporate DirectorBoard Member Oct 1, 2019
The Carle Foundation Organization, Urbana, IL Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2017 100%
Matthew Craig Kolb Individual Corporate DirectorBoard Member Jun 7, 2019
Christina Bare Individual W-2 Managing EmployeeDirector of Phyisican Practices Nov 19, 2016
James C Leonard Individual Operational/Managerial ControlChain Home Office Administrator Sep 28, 2007

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1821032525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E LOCUST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E LOCUST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502553",
            "telephone_number": "618-395-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHLAND MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "BROCKUS",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-395-7340"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olney, IL

Sources for this page

Verify at the official NPI Registry.