MT. VERNON HEALTH CARE CENTER
NPI 1780767897
Nursing Facility/Intermediate Care Facility in Mount Vernon, IL
NPI Status: Active since October 23, 2006
Contact Information
5 DOCTORS PARK RD
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 242-1064
Fax: (618) 242-7559
- Organization
- Nursing Facility/Intermediate Care Facil...
- CLIA Number: 14D0888158
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 06-23-2026
About MT. VERNON HEALTH CARE CENTER
This page provides the complete NPI Profile along with additional information for Mt. Vernon Health Care Center, a provider established in Mount Vernon, Illinois operating as a Nursing Facility/intermediate Care Facility. The healthcare provider is registered in the NPI registry with number 1780767897 assigned on October 2006. The practitioner's primary taxonomy code is 313M00000X with license number 0039800 (IL). The provider is registered as an organization and their NPI record was last updated 12 years ago. The provider's is doing business as Mt. Vernon Health Care Center. The authorized official of this NPI record is Mark B. Petersen (President)
- NPI
- 1780767897
- Provider Legal Name
- PETERSEN MANAGEMENT COMPANY, LLC
- Other Organization Name
- MT. VERNON HEALTH CARE CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 5 DOCTORS PARK RD MOUNT VERNON, IL 62864
- Location Phone
- (618) 242-1064
- Location Fax
- (618) 242-7559
- Mailing Address
- 830 W TRAILCREEK DR PEORIA, IL 61614
- Mailing Phone
- (309) 691-8113
- Mailing Fax
- (618) 242-7559
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 10-23-2006
- Last Update Date
- 05-30-2013
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nursing Facility/Intermediate Care Facility
- Taxonomy Code
- 313M00000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 0039800
- License State
- IL
- Taxonomy Description
- An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 391516877001 | MEDICAID (05) | IL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D0888158
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- June 24, 2024
- Certificate Expiration Date
- June 23, 2026
- Laboratory Director
- JAMIE M. PRANAITIS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Mt. Vernon Health Care Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 7 | 8 | 0 | 7 | 6 | 7 | 8 | 9 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 16 | 0 | 14 | 6 | 14 | 8 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 6 + 0 + 1 + 4 + 6 + 1 + 4 + 8 + 1 + 8 + 24 = 73 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 73 = 7 | 7 | ||||||||
The NPI number 1780767897 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 4 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1639687395 | AMANDA JO PORTER OTR/L Individual | Occupational Therapist | 5 DOCTORS PARK RD MOUNT VERNON, IL 62864 (618) 242-1064 |
| 1659363661 | CARAVILLA RESIDENTIAL CENTERS, INC Organization | Nursing Facility/Intermediate Care Facility | 5 DOCTORS PARK RD MOUNT VERNON, IL 62864 (618) 242-1064 |
| 1639906126 | AXIOM GARDENS OF MOUNT VERNON LLC Organization | Durable Medical Equipment & Medical Supplies | 5 DOCTORS PARK RD MOUNT VERNON, IL 62864 (618) 242-1064 |
| 1669209151 | AXIOM GARDENS OF MOUNT VERNON LLC Organization | Skilled Nursing Facility | 5 DOCTORS PARK RD MOUNT VERNON, IL 62864 (618) 242-1064 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1780767897, enumerated in the NPI registry as an "organization" on October 23, 2006
The provider is located at 5 Doctors Park Rd Mount Vernon, Il 62864 and the phone number is (618) 242-1064
This medical organization specializes in Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 14D0888158 for a "skilled nursing facility/nursing facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on October 23, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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