NPIMap

Organization Active NPI

Carlinville Area Hospital Association

Doing business as Carlinville Family Health Care

  • Rural Health Clinic/Center
  • Carlinville, IL
National Provider Identifier
1992020499
Registry record updated Nov 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARLINVILLE AREA HOSPITAL ASSOCIATION
Doing business as
Carlinville Family Health Care
Practice address
20613 N Broad St Ste B
Carlinville, IL 62626-3721
Phone
(217) 854-3881
Fax
(217) 854-3894
NPI assigned
Mar 29, 2010
Last updated
Nov 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2026

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

Authorized official

Name
Brian Burnside
Title
Chief Financial Officer
Phone
(217) 854-3141

Specialties & licenses 1

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

Addresses

Primary practice location

20613 N Broad St Ste B
Carlinville, IL 62626-3721

Mailing address

20613 N Broad St Ste B
Carlinville, IL 62626-3721
Phone (217) 854-3881

Other names 1

  • Carlinville Family Health Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031104000520 IL Part B Supplier - Clinic/Group Practice 9032021373 Receives reassigned benefits from 77 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carlinville, IL; Gillespie, IL; Girard, IL; Virden, IL
O20130731000387 IL Part A Provider - Rural Health Clinic 9032021373 Practice locations: Carlinville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992020499. Details of each certification follow.

Rural health clinic certification: CCN 148530

Legal name
CARLINVILLE AREA HOSPITAL ASSOCIATION
Doing business as
CARLINVILLE FAMILY HEALTH CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 25, 2013
Last certification
Nov 25, 2013
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
20613 N Broad St
Ste B
Carlinville, IL 62626-3721
Related CCNs
141347

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

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 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2021868Carlinville Family Health Care20613 N Broad St, Carlinville, IL 62626Certificate of waiverMar 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Carlinville Area Hospital14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

807 Broadway St
Gillespie, IL 62033
Phone (217) 839-3900

Interoperability endpoints

  • Direct secure messaging: aarongreenspan@cah.allscriptsdirect.net
  • Direct secure messaging: abigailwhite@cah.allscriptsdirect.net
  • Direct secure messaging: annalentini@cah.allscriptsdirect.net
  • Direct secure messaging: ashleysimons@cah.allscriptsdirect.net
  • Direct secure messaging: ashleytalkington@cah.allscriptsdirect.net
  • Direct secure messaging: brittanicunningham@cah.allscriptsdirect.net
  • Direct secure messaging: danielhallam@cah.allscriptsdirect.net
  • Direct secure messaging: haraldlausen@cah.allscriptsdirect.net
  • Direct secure messaging: jamiewelty@cah.allscriptsdirect.net
  • Direct secure messaging: jennifertinsley@cah.allscriptsdirect.net
  • Direct secure messaging: jessicaheil@cah.allscriptsdirect.net
  • Direct secure messaging: katewilkens@cah.allscriptsdirect.net
  • Direct secure messaging: rebbeccacamerer@cah.allscriptsdirect.net
  • Direct secure messaging: ruthholley@cah.allscriptsdirect.net
  • Direct secure messaging: sherryslifer@cah.allscriptsdirect.net
  • Direct secure messaging: shonaquick@cah.allscriptsdirect.net
  • Direct secure messaging: tawnythomas@cah.allscriptsdirect.net
  • Direct secure messaging: theresepolo@cah.allscriptsdirect.net
  • Direct secure messaging: thomashatley@cah.allscriptsdirect.net

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jay Hodges Individual Corporate OfficerCfo Nov 1, 2024
Richard Walden Individual Operational/Managerial Control Jul 1, 2005
Jim Salske Individual Corporate DirectorBoard Member Jul 1, 2005
Brian D Burnside Individual Corporate OfficerCeo/President Aug 1, 2020
W-2 Managing EmployeeCeo Aug 1, 2020
Operational/Managerial ControlCeo/President Aug 1, 2020
Katie M Goodman-Thomas Individual Corporate DirectorBoard Member Jan 1, 2022
Heather Anne Deneve Individual Corporate DirectorBoard Treasurer Jan 1, 2018
Middle Macoupin Healthcare Systems, Inc. Organization, Carlinville, IL 5% Or Greater Indirect Ownership Interest Jun 18, 2013 100%
Tom Denby Individual Corporate DirectorBoard Member Jan 1, 2022
Dennis Pickrel Individual Corporate DirectorBoard Member Jan 1, 2013
Carlinville Area Hospital Association Organization, Carlinville, IL Non-profit 5% Or Greater Direct Ownership Interest Jun 18, 2013 100%
Operational/Managerial Control Nov 26, 2002
Kristin Boldt Individual Corporate DirectorAssistant Cfo and Revenue Cycle Dir Feb 11, 2025

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Virden Family Health CareVirden, IL, CCN 148532 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2013

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793836800000",
    "number": "1992020499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20613 N BROAD ST STE B",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626263721",
            "telephone_number": "217-854-3881",
            "fax_number": "217-854-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20613 N BROAD ST STE B",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626263721",
            "telephone_number": "217-854-3881",
            "fax_number": "217-854-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLINVILLE AREA HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-29",
        "last_updated": "2026-11-05",
        "certification_date": "2026-11-05",
        "status": "A",
        "authorized_official_last_name": "BURNSIDE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "217-854-3141"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carlinville Family Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carlinville, IL

Sources for this page

Verify at the official NPI Registry.