PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION (NPI# 1629115050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629115050 |
| Entity Type | Organization |
| Organization Name | PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION |
| Other Organization Name | PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION |
| Practice Address |
1600 W Walnut St Jacksonville IL 62650 |
| Mailing Address |
1600 W Walnut St Jacksonville IL 62650-1136 |
| Practice Telephone | 2172459541 |
| Practice Fax Number | 2174798781 |
| Mailing Telephone | 2172459541 |
| Mailing Fax Number | 2174798781 |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2018-08-09 |
| Authorized Official Name | MR. ROBERT L SILTMAN (DIRECTOR, PATIENT FINANCIAL SERVICE) |
| Authorized Official Telephone | 2172459541 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEMORIAL HEALTH SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | ========= | IL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 50317 | 01 |
| Other Name | Type Code |
|---|---|
| PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760994040 | Passavant Memorial Area Hospital Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-10-26 |
| 1366813404 | Passavant Memorial Area Hospital Association | Psychiatric Unit | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2015-10-15 |
| 1558530956 | Passavant Memorial Area Hospital Association | General Acute Care Hospital | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2008-02-29 |
| 1689780520 | Passavant Memorial Area Hospital Association | Dietitian, Registered | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2006-08-22 |
| 1497861330 | Passavant Memorial Area Hospital Association | General Acute Care Hospital | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2006-08-22 |
| 1174580831 | Passavant Memorial Area Hospital Association | General Acute Care Hospital | 1600 W Walnut St, Jacksonville, IL 62650 | 2006-04-27 |
| Street Address |
1600 W WALNUT ST |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609873249 | Charles Milton Sheaff | Surgery | 1600 W Walnut St, East Wing 2nd Floor, Jacksonville, IL 62650-1136 | 2005-06-28 |
| 1528690799 | Holly Diane Pennell | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-06 |
| 1669004081 | Elizabeth Ann Johnson | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-05 |
| 1164053526 | Kayla Christine Vickers | Physical Therapist | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-03 |
| 1366912040 | Kelsi Lynn Dobson | Social Worker | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-11-26 |
| 1114402518 | Michelle Lee Geiss | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-10-02 |
| 1134606858 | Matthew Pulley | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-07-25 |
| 1760994040 | Passavant Memorial Area Hospital Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-10-26 |
| 1871002238 | Courtney Howell | Social Worker | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-09-28 |
| 1831639194 | Carrie Elizabeth Janus | Nurse Practitioner | 1600 W Walnut St, The Center for Psychiatric Health, Jacksonville, IL 62650-1136 | 2017-03-06 |
| 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 | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578199303 | First Coast Health Ventures, LLC | Skilled Nursing Facility | 15480 Max Leggett Parkway, Jacksonville, FL 32218 | 2020-03-12 |
| 1992336895 | Dolphin Pointe Health Care, LLC | Skilled Nursing Facility | 5355 Dolphin Point Rd., Jacksonville, FL 32211 | 2020-01-29 |
| 1629439260 | West Jax Geriatrics, LLC | Skilled Nursing Facility | 730 College St, Jacksonville, FL 32204-3313 | 2016-03-10 |
| 1376955377 | Edwin Bato | Skilled Nursing Facility | 3434 Nightscape Cir, Jacksonville, FL 32224-1618 | 2014-05-24 |
| 1508138678 | Terri Velinda Virgil | Skilled Nursing Facility | 11555 Birch Forest Circle East, Jacksonville, FL 32218 | 2012-02-03 |
| 1689993032 | Jacksonville Scc, LLC | Skilled Nursing Facility | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2010-05-25 |
| 1326362005 | Brooks Skilled Nursing Facility, A, Inc. | Skilled Nursing Facility | 6209 Brooks Bartram Dr. Bldg 100, Jacksonville, FL 32258 | 2010-03-24 |
| 1144476946 | Magnus Opus Technology | Skilled Nursing Facility | 7000 Northlake Dr, Jacksonville, AR 72076-4959 | 2008-08-12 |
| 1972796175 | Russell Wayne Tolliver | Skilled Nursing Facility | 4083 Sunbeam Rd, Apartment 1409, Jacksonville, FL 32257-8993 | 2007-08-21 |
| 1750409082 | Patti Sperling Arnp LLC | Skilled Nursing Facility | 402 Myrtlewood Cir, Jacksonville, NC 28546-7412 | 2007-03-26 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION.
| 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.