Richland Memorial Hospital, Inc
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Olney, IL
NPI 1821032525 · NPPES record last updated Dec 22, 2020
Key facts
- NPI
- 1821032525
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 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
- Organization subpart
- No
Authorized official
- Name
- Harry Brockus
- Title
- Ceo
- Phone
- (618) 395-7340
Owners & managing parties with NPI records 4
-
Brian Lee Atwood, M.D.
-
Raymond Fisher, M.D.
-
Tanner M Miller, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 6
Related certifications (CCN) 1
Facilities with the same owner 31
Practitioners 107
-
Naveed A Adoni I, MD
-
Michael Aref, MD
-
Loranda Lee Banker, MS,RD,LDN
-
Christopher Baptist, D.P.M.
-
Brian Robert Beeman, M.D.
-
Mark Thomas Behnam, M.D.
-
Makayla Bogard, NP-C
-
Andrea Brasch, MD
-
Laura Browning, PA
-
Kelcy Marie Carlson, PMHNP-BC
-
Benjamin Shawn Curtis, CRNA
-
Thomas Deschler, MD
-
Thomas Falcone, CRNA
-
Yekaterina Fayn, MD
-
Raymond Fisher, M.D.
-
John D Fulk, P.A.
-
Nona P Fulk, M.D.
-
Anuj Garg, MD
Affiliated clinicians 5
-
Brian Lee Atwood, M.D.
-
Tanner M Miller, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Hospital certification: CCN 14Z355
- Legal name
- RICHLAND MEMORIAL HOSPITAL INC
- Doing business as
- CARLE RICHLAND MEMORIAL HOSPITAL
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 30, 1996 in IL
- Enrollment address
- 800 E Locust St
Olney, IL 62450-2553
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Brian L Atwood |
Corporate Director |
Jan 1, 2019 | |
| Steven T Thomson |
Corporate Director |
Oct 1, 2022 | |
| Larry D Dunn |
Corporate Director |
Oct 26, 2021 | |
| Tanner M Miller |
Corporate Director |
Jan 1, 2022 | |
| Raymond L Fisher |
Corporate Director |
Oct 1, 2020 | |
| Sherry L Geier |
Corporate Director |
Oct 26, 2021 | |
| Bernard Eugene Brauer |
Corporate Director |
Oct 1, 2022 | |
| Regina Rachel Thomas |
Corporate Officer |
Mar 4, 2021 | |
| W-2 Managing Employee |
Mar 4, 2021 | ||
| Jennifer Cummins-Zuber |
Corporate Director |
Oct 23, 2018 | |
| Gary Houchin |
Corporate Director |
Oct 23, 2018 | |
| Patricia Lynn Kessler-Bookhout |
Corporate Director |
Oct 1, 2019 | |
| The Carle Foundation |
5% Or Greater Direct Ownership Interest | Apr 1, 2017 | 100% |
| Matthew Craig Kolb |
Corporate Director |
Jun 7, 2019 | |
| Christina Bare |
W-2 Managing Employee |
Nov 19, 2016 | |
| James C Leonard |
Operational/Managerial Control |
Sep 28, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240816000207 | IL | Part a Provider - Critical Access Hospital | 3870565732 |
1 other NPI on this enrollment Practice locations: Olney, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
800 E Locust St
Olney, IL 62450-2553
Mailing address
800 E Locust St
Olney, IL 62450-2553
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0976 | Other | IL | BLUE CROSS |
Other providers in Olney, IL
- Richland Memorial Hospital, Inc
- Richland Memorial Hospital, Inc
- Richland Memorial Hospital, Inc
- Richland Memorial Hospital, Inc
- Richland Memorial Hospital, Inc
- Richland Memorial Hospital, Inc.
- Dora Mae Riley
- Rincker Residential Services, Inc.
- Jazlyn Robinson
- Antonio Rodriguez
All providers in Olney, IL · Medicare Defined Swing Bed Hospital Unit in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.