NPIMap

Organization Active NPI

Hoopeston Community Memorial Hospital

  • Rural Health Clinic/Center
  • Milford, IL
National Provider Identifier
1992059976
Registry record updated Dec 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Practice address
322 N. Chicago Street
Milford, IL 60953-1409
Phone
(217) 283-8540
Fax
(217) 283-4062
NPI assigned
Oct 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2013

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

Authorized official

Name
Mr. Harry Brockus
Title
Ceo
Phone
(217) 283-8540

Specialties & licenses 1

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

Addresses

Primary practice location

322 N. Chicago Street
Milford, IL 60953-1409

Mailing address

701 E Orange St
Hoopeston, IL 60942-1801
Phone (217) 383-6792

Other names 1

  • Milford 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
O20121221000021 IL Part A Provider - Rural Health Clinic 3577456037 Practice locations: Milford, IL

Rural health clinic certification: CCN 148526

Legal name
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Doing business as
CARLE MILFORD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 22, 2013
Last certification
Jul 22, 2013
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 3, 1956 in IL
Enrollment address
322 N Chicago St
Milford, IL 60953-1012
Related CCNs
141316

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

Other NPIs with the same Medicare PAC ID 10

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

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
14D2046854Milford Medical Clinic322 Chicago St, Milford, IL 60953Certificate of waiverSep 11, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hoopeston Hospital Ambu11 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.

Locations

322 N Chicago St
Milford, IL 60953
Phone (815) 889-4011

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
Laura Williams Individual Corporate DirectorBoard Member Jan 1, 2022
Sally J Salmons Individual Corporate Director Jan 26, 2017
Allison Slocum Individual Corporate Director Jan 1, 2020
Karla J Coon Individual Corporate DirectorBoard Member Jan 1, 2021
William Nicholls Individual Corporate Director Jun 14, 2019
Heather Tucker Individual Corporate OfficerHospital Administrator Aug 14, 2020
Corporate DirectorHospital Administrator Aug 14, 2020
W-2 Managing EmployeeHospital Administrator Aug 14, 2020
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 3, 2012 100%
Larry Baughn Individual Corporate DirectorBoard Member Jan 1, 2022
James C Leonard Individual OtherChain Home Office Administrator Nov 1, 2012

Owners & managing parties with NPI records 1

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

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 142

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 142

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1992059976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E ORANGE ST",
            "city": "HOOPESTON",
            "state": "IL",
            "postal_code": "609421801",
            "telephone_number": "217-383-6792",
            "fax_number": "217-383-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 N. CHICAGO STREET",
            "city": "MILFORD",
            "state": "IL",
            "postal_code": "609531409",
            "telephone_number": "217-283-8540",
            "fax_number": "217-283-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOOPESTON COMMUNITY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "BROCKUS",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-283-8540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Milford Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milford, IL

Sources for this page

Verify at the official NPI Registry.