NPIMap

Organization Active NPI

Macoupin Family Practice Centers, LLP

Doing business as Mt Olive Family Practice Center

  • Rural Health Clinic/Center
  • Mount Olive, IL
National Provider Identifier
1881894533
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MACOUPIN FAMILY PRACTICE CENTERS, LLP
Doing business as
Mt Olive Family Practice Center
Practice address
115 N Poplar St
Mount Olive, IL 62069-1613
Phone
(217) 999-4751
NPI assigned
Jul 20, 2007
Last updated
Jun 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Authorized official

Name
Dr. Bruce F Weber
Title
Director
Phone
(217) 999-4751

Specialties & licenses 1

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

Addresses

Primary practice location

115 N Poplar St
Mount Olive, IL 62069-1613

Mailing address

115 N Poplar St
Mount Olive, IL 62069-1613
Phone (217) 999-4751

Other names 1

  • Mt Olive Family Practice Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030114000003 IL Part A Provider - Rural Health Clinic 2365350253 Practice locations: Mount Olive, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881894533. Details of each certification follow.

Rural health clinic certification: CCN 143863

Legal name
MACOUPIN FAMILY PRACTICE CENTERS LLP
Doing business as
MOUNT OLIVE FAMILY PRACTICE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 7, 1994
Last certification
May 8, 2026
Ownership / control type
1C
Most recent change of ownership
Feb 1, 1998 (1 total)
Organization structure
PartnershipProprietary
Enrollment address
115N Poplar St
Mount Olive, IL 62069-1613

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Macoupin Family Practice Centers LLP7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the 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
Bruce Frank Weber Individual General Partnership InterestPartner Nov 1, 2002 33.3%
Brian Quarton Individual General Partnership InterestPartner Nov 1, 2002 33.3%
Jennifer Henrichs Individual W-2 Managing EmployeePractice Manager Jan 1, 2003 50%

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1881894533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N POPLAR ST",
            "city": "MOUNT OLIVE",
            "state": "IL",
            "postal_code": "620691613",
            "telephone_number": "217-999-4751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N POPLAR ST",
            "city": "MOUNT OLIVE",
            "state": "IL",
            "postal_code": "620691613",
            "telephone_number": "217-999-4751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACOUPIN FAMILY PRACTICE CENTERS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-999-4751",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt Olive Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt Olive Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Olive, IL

Sources for this page

Verify at the official NPI Registry.