NPIMap

Organization Active NPI

Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Carlinville, IL
National Provider Identifier
1861800526
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
371001351006 Issued in IL
Legal business name
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Practice address
1115 Morgan St
Carlinville, IL 62626-1430
Phone
(217) 854-3692
NPI assigned
Jul 25, 2014
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
Mr. Christy Blank
Title
Chief Executive Officer
Phone
(217) 930-2283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 371001351006 IL Primary

Addresses

Primary practice location

1115 Morgan St
Carlinville, IL 62626-1430

Mailing address

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

Other names 1

  • Macoupin County Public Health Clinic Site Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

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
O20141112000630 IL Part A Provider - Federally Qualified Health Center (FQHC) 1557377850 1 other NPI on this enrollment
Practice locations: Carlinville, IL

Federally qualified health center certification: CCN 781864

Legal name
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2014
Last certification
Dec 5, 2014
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Oct 20, 2010 in IL
Enrollment address
1115 Morgan St
Carlinville, IL 62626-1430

Other NPIs with the same Medicare PAC ID 5

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

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 Feb 21, 2012 100%
Lori Sanson Individual W-2 Managing EmployeeCfo Dec 1, 2022
Operational/Managerial ControlCfo Dec 1, 2022

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Macoupin County Public Health DepartmentGillespie, IL, CCN 141154 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 20, 2010
Macoupin County Public Health DepartmentCarlinville, IL, CCN 141824 Federally qualified health center Operational/Managerial Control Sep 1, 2014

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1861800526",
    "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": "1115 MORGAN ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261430",
            "telephone_number": "217-854-3692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-25",
        "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": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "217-930-2283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": "371001351006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macoupin County Public Health Clinic Site",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Macoupin County Public Health Clinic Site",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carlinville, IL

Sources for this page

Verify at the official NPI Registry.