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Organization Active NPI

Julia Rackley Perry Memorial Hospital

Doing business as Perry Memorial Family Health Clinic

  • Primary Care Clinic/Center
  • Princeton, IL
National Provider Identifier
1922411602
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Doing business as
Perry Memorial Family Health Clinic
Practice address
530 Park Ave E
Princeton, IL 61356-3901
Phone
(815) 876-4419
Fax
(815) 876-4455
NPI assigned
Jun 10, 2014
Last updated
Jun 15, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
JULIA RACKLEY PERRY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Authorized official

Name
Jean Welte
Title
Medical Staff Services Coordinator
Phone
(815) 876-2293

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

530 Park Ave E
Princeton, IL 61356-3901

Mailing address

530 Park Ave E
Princeton, IL 61356-3901
Phone (815) 876-4419

Other names 1

  • Perry Memorial Family Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Gary Bruce Individual Corporate DirectorBoard Member Oct 20, 2003
Julia Rackley Perry Memorial Hospital Organization, Princeton, IL 5% Or Greater Direct Ownership Interest Aug 25, 2014 100%
Anthony Sorcic Individual Corporate OfficerVice-Chairman Nov 4, 2002
Linda Gustafson Individual Corporate OfficerSecretary Oct 6, 2003
Thomas Tester Individual Corporate DirectorBoard Member Jul 7, 1997
Gregg E Davis Individual Corporate DirectorBoard Member Apr 18, 2011
Rick Clary Individual Corporate OfficerChairman Oct 1, 2001
Scott a Hartman Individual Corporate OfficerInterim Ceo Mar 1, 2021
W-2 Managing EmployeeInterim Ceo Mar 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1922411602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-876-4419",
            "fax_number": "815-876-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-876-4419",
            "fax_number": "815-876-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JULIA RACKLEY PERRY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JULIA RACKLEY PERRY MEMORIAL HOSPITAL",
        "enumeration_date": "2014-06-10",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "WELTE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "MEDICAL STAFF SERVICES COORDINATOR",
        "authorized_official_telephone_number": "815-876-2293"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perry Memorial Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perry Memorial Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, IL

Sources for this page

Verify at the official NPI Registry.