NPIMap

Organization Active NPI

Wabash General Hospital District

Doing business as Grayville Medical Clinic

  • Rural Health Clinic/Center
  • Grayville, IL
National Provider Identifier
1942774153
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WABASH GENERAL HOSPITAL DISTRICT
Doing business as
Grayville Medical Clinic
Practice address
610 N Court St
Grayville, IL 62844-1002
Phone
(618) 375-7101
Fax
(618) 375-7183
NPI assigned
Jan 22, 2019
Last updated
Sep 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Authorized official

Name
Karissa Lynn Turner
Title
Ceo
Phone
(618) 263-6300

Specialties & licenses 1

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

Addresses

Primary practice location

610 N Court St
Grayville, IL 62844-1002

Mailing address

1418 College Dr
Mount Carmel, IL 62863-2638
Phone (618) 262-8621

Other names 1

  • Grayville Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190220001710 IL Part A Provider - Rural Health Clinic 8022908185 Practice locations: Grayville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942774153. Details of each certification follow.

Rural health clinic certification: CCN 148613

Legal name
WABASH GENERAL HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 27, 2020
Last certification
Jul 27, 2020
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1949 in IL
Enrollment address
610 N Court St
Grayville, IL 62844-1002
Related CCNs
141327

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Wabash General Hospital11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Karissa L Turner Individual Corporate OfficerCeo Jan 1, 2019 5%
Corporate DirectorCeo Jan 1, 2019 5%
Operational/Managerial ControlCeo Jan 1, 2019 5%
Kevin E Raber Individual Corporate DirectorSecretary Board of Directors Apr 2, 2018 5%
Operational/Managerial ControlSecretary of the Board of Directors Apr 2, 2018 5%
Toni L Brines Individual Corporate OfficerChairman of the Board Jan 1, 2015 5%
Operational/Managerial ControlChairman of the Board Jan 1, 2015 5%
Janet L Storey Individual Corporate OfficerTreasurer of the Board of Direct Jan 1, 1989 5%
Operational/Managerial ControlTreasurer of the Board of Direct Jan 1, 1989 5%
William Easton Individual Corporate DirectorMember, Board of Directors Oct 1, 2010 5%
Operational/Managerial ControlMember, Board of Directors Oct 1, 2010 5%
Zed Moore Individual Corporate OfficerBoard Member Jan 1, 2025
Doug McPherson Individual Corporate OfficerVice Chairman Mar 21, 2016 5%
Operational/Managerial ControlVice Chairman Mar 21, 2016 5%
John a Evans Individual Corporate DirectorMember, Board of Directors Feb 1, 2009 5%
Operational/Managerial ControlMember, Board of Directors Feb 1, 2009 5%
Robert J Coleman Individual Corporate OfficerBoard Member Jan 1, 1995 5%
Operational/Managerial ControlBoard Member Jan 1, 1995 5%
Tara Gould Individual W-2 Managing EmployeeManaging Employee Oct 27, 2025

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Wabash General Hospital-Dba-Convenient CareMount Carmel, IL, CCN 148501 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 4, 2002

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1942774153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 COLLEGE DR",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628632638",
            "telephone_number": "618-262-8621",
            "fax_number": "618-263-6467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N COURT ST",
            "city": "GRAYVILLE",
            "state": "IL",
            "postal_code": "628441002",
            "telephone_number": "618-375-7101",
            "fax_number": "618-375-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WABASH GENERAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "KARISSA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-263-6300"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grayville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grayville, IL

Sources for this page

Verify at the official NPI Registry.