PRAIRIE FAMILY MEDICINE AND OBSTETRICS
NPI 1063462976
Clinic/Center - Rural Health in Forrest, IL

Q: What is Gibson Community Hospital Association's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Active since May 11, 2006CLIA 14D0941464 · Microscopy

122 E WABASH AVE, FORREST, IL 61741(815) 657-8707(815) 657-8717 Get Directions Write a Review

NPPES record last updated: February 4, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 4, 2022, Sep 3, 2019 (2 updates tracked since 2019).

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About Prairie Family Medicine And Obstetrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRAIRIE FAMILY MEDICINE AND OBSTETRICS (NPI 1063462976) is a healthcare organization registered as a rural health in Forrest, Illinois and active in the NPI registry since May 2006. The organization holds a CLIA Microscopy certificate valid through February 24, 2028 and lists Matthew Ertel, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1063462976

Entity TypeOrganization

Primary Taxonomy261QR1300X

Legal Business NameGIBSON COMMUNITY HOSPITAL ASSOCIATION

Location Address122 E WABASH AVEForrest, IL 61741-9369

Mailing Address122 E Wabash AveForrest, IL 61741-9369 · (815) 657-8707 · Fax (815) 657-8717

Phone(815) 657-8707

Fax(815) 657-8717

Organization SubpartYes

Authorized OfficialMatthew ErtelChief Financial Officer · (217) 784-2601

Enumeration DateMay 11, 2006

Last NPPES UpdateFebruary 4, 20222 updates tracked since enumeration

NPPES CertifiedFebruary 4, 2022

✔ NPI 1063462976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities

Taxonomy Code261QR1300X

Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X

122 E WABASH AVE, Forrest, IL 61741

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Other Names 1

Doing Business AsPrairie Family Medicine And Obstetrics

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D0941464

Prairie Family Medicine And Obstetrics Ltd · Forrest, IL

Active · expires Feb 24, 2028

CLIA Number14D0941464

Laboratory TypePhysician Office

Certificate Effective DateFebruary 25, 2026

Certificate Expiration DateFebruary 24, 2028

Laboratory DirectorBenjamin E. Brewer MD

Laboratory Phone(815) 657-8707

Laboratory LocationPrairie Family Medicine And Obstetrics Ltd122 E Wabash PO Box 58, Forrest, IL 61741

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FORREST FAMILY PRACTICE CENTER LLC

Family Medicine