NPIMap

Organization Active NPI

Rural Health, Inc.

Doing business as Goreville Medical Center

  • Federally Qualified Health Center (FQHC)
  • Goreville, IL
National Provider Identifier
1962763045
Registry record updated Apr 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH, INC.
Doing business as
Goreville Medical Center
Practice address
400 S Broadway
Goreville, IL 62939-2444
Phone
(618) 995-1002
Fax
(618) 995-1133
NPI assigned
Jun 5, 2012
Last updated
Apr 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2016

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

Authorized official

Name
Ms. Cynthia K Flamm, MSW, LCSWNPI 1891223533
Title
Chief Executive Officer
Phone
(618) 833-4471

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

400 S Broadway
Goreville, IL 62939-2444

Mailing address

513 N Main St
Anna, IL 62906-1668
Phone (618) 833-4471

Other names 1

  • Goreville Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120814000601 IL Part A Provider - Federally Qualified Health Center (FQHC) 6800705427 Practice locations: Goreville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962763045. Details of each certification follow.

Federally qualified health center certification: CCN 141167

Legal name
RURAL HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 28, 2012
Last certification
Sep 28, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 29, 1978 in IL
Enrollment address
211 N Broadway
Goreville, IL 62939-2323

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Physicians8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

211 N Broadway
Goreville, IL 62939
Phone (618) 995-1002

400 S Broadway
Goreville, IL 62939
Phone (618) 995-1002

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Steve Webb Individual Corporate DirectorBoard Member May 18, 2022 10%
Leticia Vicente Individual Corporate DirectorBoard Member Jan 1, 2000 10%
Deirdre Hoedebecke Individual Corporate DirectorBoard Member Sep 1, 2017 10%
Terry J Lingle Individual Corporate DirectorBoard Member Aug 1, 2005 10%
Cynthia K Flamm Individual 5% Or Greater Direct Ownership Interest Aug 6, 2012 20%
W-2 Managing EmployeeCeo Aug 16, 2012 5%
Christopher a Clark Individual Corporate DirectorBoard Member Aug 1, 2012 10%
Tyler R Edmonds Individual Corporate DirectorBoard Member Jan 19, 2011 10%
Sheri M Lukes Individual Corporate Director May 16, 2018 10%
Diana L Dodds Individual Corporate Director Aug 15, 2018 10%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1962763045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061668",
            "telephone_number": "618-833-4471",
            "fax_number": "618-833-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S BROADWAY",
            "city": "GOREVILLE",
            "state": "IL",
            "postal_code": "629392444",
            "telephone_number": "618-995-1002",
            "fax_number": "618-995-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-05",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "FLAMM",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "618-833-4471",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goreville Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goreville, IL

Sources for this page

Verify at the official NPI Registry.