CMS-1500 Box 24J / 33a • NPI
1457476640
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
313M00000X (CMS A3[10])
Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility
Box 32 Service Location & ZIP+4
1740 W MCCORD ST, CENTRALIA, IL, 62801-5808
✓ 9-Digit EDI 837 ZIP+4 (62801-5808)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1457476640 (BROOKSIDE MANOR LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1457476640 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | BROOKSIDE MANOR LLC |
| Plain-English Specialty | Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility NUCC Code: 313M00000X (Nursing Facility/Intermediate Care Facility) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1740 W MCCORD ST, CENTRALIA, IL, 62801-5808 |
| Practice Telephone / Fax | Tel: (618) 532-2428 | Fax: (618) 532-8305 |
| Administrative Mailing Address | 1740 W MCCORD ST, CENTRALIA, IL, 62801-5808 |
| Enumeration & Last Sync | Enumerated: 2007-03-20 | CMS Record Updated: 2020-08-22 |
| Authorized Official | LISA MIDDLETON (Administrator) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in CENTRALIA
🔒 Are you BROOKSIDE MANOR LLC? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (313M00000X)
What Does Taxonomy Code 313M00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 313M00000X translates to:
"Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (BROOKSIDE MANOR LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
313M00000X — Nursing Facility/Intermediate Care FacilityPlain English: Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility | State: IL | License: 00045096 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.