JERSEY COMMUNITY HOSPITAL (NPI# 1114322286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1114322286 |
Entity Type | Organization |
Organization Name | JERSEY COMMUNITY HOSPITAL |
Other Organization Name | JCH MEDICAL GROUP-JACKSONVILLE |
Practice Address |
1440 W Walnut St Suite 2a Jacksonville IL 62650-1143 |
Mailing Address |
390 Maple Summit Rd Jerseyville IL 62052-2000 |
Practice Telephone | 2172433543 |
Practice Fax Number | 2172432323 |
Mailing Telephone | 6184987518 |
Mailing Fax Number | 6184983052 |
Enumeration Date | 2014-10-30 |
Last Update Date | 2017-08-21 |
Authorized Official Name | MRS. BETH A KING (CFO) |
Authorized Official Telephone | 6184988350 |
Is Organization Subpart | Y |
Parent Organization Name | JERSEY COMMUNITY HOSPITAL |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 208000000X | Pediatrics | 0001156 | IL | Allopathic & Osteopathic Physicians |
Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
0001156 | IL | Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
JCH Medical Group-Jacksonville | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285272807 | Jersey Community Hospital | Obstetrics & Gynecology | #2 Memorial Drive, Suite 203, Alton, IL 62002 | 2019-12-13 |
1770988735 | Jersey Community Hospital | Clinic/Center | 414 S State St, Roodhouse, IL 62082-1544 | 2014-11-03 |
1922403096 | Jersey Community Hospital | Obstetrics & Gynecology | 2 Memorial Dr Ste 203, Alton, IL 62002-6723 | 2014-10-30 |
1700423696 | Jersey Community Hospital | Family Medicine | 903 S State St, Jerseyville, IL 62052-2344 | 2019-12-10 |
1710461777 | Jersey Community Hospital | Durable Medical Equipment & Medical Supplies | 400 Maple Summit Rd, Suite 100, Jerseyville, IL 62052-2028 | 2018-09-17 |
1548744501 | Jersey Community Hospital | Social Worker | 220 E County Rd, Jerseyville, IL 62052-3125 | 2018-09-17 |
1659750818 | Jersey Community Hospital | Family Medicine | 270 Maple Summit Rd, Jerseyville, IL 62052-2004 | 2015-05-21 |
1689079642 | Jersey Community Hospital | Clinic/Center | 523 S Main St, Carrollton, IL 62016-1256 | 2014-11-03 |
1417352527 | Jersey Community Hospital | Clinic/Center | 2 Myrtle Lane, Hardin, IL 62047 | 2014-10-31 |
1730584806 | Jersey Community Hospital | Psychiatry & Neurology | 815 E 5th St, Suite 205, Alton, IL 62002-6471 | 2014-10-30 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | JERSEY COMMUNITY HOSPITAL DISTRICT | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 |
Street Address |
1440 W WALNUT ST SUITE 2A |
City | JACKSONVILLE |
State | IL |
Zip Code | 62650-1143 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770576829 | Peter Damon Russotto | Podiatrist | 1440 W Walnut St, #5, Jacksonville, IL 62650-1143 | 2005-08-24 |
1972023117 | Ethan Duewer | Dentist | 1440 W Walnut St, Jacksonville, IL 62650-1143 | 2017-06-20 |
1205282936 | Central Counties Health Centers, Inc. | Physician Assistant | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650-1143 | 2016-05-12 |
1891034294 | Illini Medical Associates, Sc | Pediatrics | 1440 W Walnut St, Ste 2a, Jacksonville, IL 62650-1143 | 2013-02-05 |
1558480418 | Physical Therapists Clinic,ltd | Clinic/Center | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650-1143 | 2007-03-29 |
1083769475 | Physical Therapists Clinic, Ltd | Physical Therapist | 1440 W Walnut St, Suite2, Jacksonville, IL 62650-1143 | 2007-01-24 |
1174608533 | Donald Robert Beckett Jr. | Dentist | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650 | 2006-10-26 |
1336179712 | Amy Jo Blanford | Physical Therapist | 1440 W Walnut St, Building #2, Jacksonville, IL 62650-1143 | 2006-07-03 |
1245203439 | Linda V Stevens-schilsky | Pediatrics | 1440 W Walnut St, Jacksonville, IL 62650 | 2006-02-09 |
1043299803 | Abby G Henry | Physical Therapist | 1440 W Walnut St, #2, Jacksonville, IL 62650-1143 | 2006-01-11 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
Find all providers in zip 62650 |
Taxonomy Code | 261QR1300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Rural Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053804443 | Siu Physicians & Surgeons, Inc | Clinic/Center | 610 N Westgate Ave, Jacksonville, IL 62650-1152 | 2018-06-11 |
1861991226 | Jacksonville Hospital LLC | Clinic/Center | 203 Nacogdoches St Ste 280, Jacksonville, TX 75766-2444 | 2018-02-12 |
1922410836 | Passavant Physician Association | Clinic/Center | 557 N Westgate Ave, Jacksonville, IL 62650-1156 | 2014-05-27 |
1205180056 | Memorial Physician Services | Clinic/Center | 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650-1136 | 2012-11-01 |
1104179415 | Memorial Physician Services | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2012-10-24 |
1558614867 | Memorial Physician Services | Clinic/Center | 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 | 2012-10-24 |
1881947174 | Memorial Physician Services | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2012-10-24 |
1821366170 | East Texas Medical Center Jacksonville | Clinic/Center | 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2444 | 2011-12-01 |
1598068793 | Springfield Clinic LLP | Clinic/Center | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2010-12-09 |
1619129897 | Jacksonville, LLC | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2008-10-21 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 62650 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.