Mercy Crystal Lake Hospital and Medical Center Inc
Organization Active NPI General Acute Care Hospital · Crystal Lake, IL
NPI 1023754371 · NPPES record last updated Apr 2, 2026
Key facts
- NPI
- 1023754371
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- Legal business name
- MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC
- Practice address
- 875 S Route 31
Crystal Lake, IL 60014 - Phone
- (608) 756-6080
- Fax
- (608) 756-6236
- NPI assigned
- May 10, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY HEALTH CORPORATION
Authorized official
- Name
- Shannon Dunphy-Alexander
- Title
- Cfo
- Phone
- (608) 757-3126
Owners & managing parties with NPI records 2
-
John T. Dorsey, MD
-
Mark L Goelzer, MD
Corporate family (same tax ID) 1
Facilities with the same owner 14
Practitioners 8
-
James Chatham Jr., M.D.
-
Patrick L. McCarthy, M.D.
-
Atul Jayant Patel, M.D.
-
Ari D Plosker, M.D.
-
Aaron Jun, M.D.
-
Gregory J Orth, MD
Affiliated clinicians 134
-
Umber Ahmad, DO
-
Ather Ali, MD
-
Sheila Atendido, CRNA
-
Shazia Azmat, MD
-
Humaira Bari, MD
-
Jessica Barrera, APN
-
Harpreet S Basran, M.D.
-
Tracy Bedford, CRNA
-
Wendy M Belletynee, APN, FNP-C, FPA
-
Douglas H Bryan, MD
-
Terrence J Bugno, MD
-
Bijal Patel Chaturvedi, CRNA
-
Ernest A Conti, MD
-
Amarish A Dave, DO
-
Scott Detloff, PA-C
-
Kathleen Fisher, FNP
-
Haile E Fitzgerald, DNP, CRNA, APRN
Medicare Care Compare: Hospital
- Listed as
- Mercyhealth Hospital & Physician Clinic-Crystal la
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Hospital certification: CCN 140308
- Legal name
- MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC
- Doing business as
- MERCYHEALTH HOSPITAL AND PHYSICIAN CLINIC-CRYSTAL LAKE
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Sep 20, 2023
- Last certification
- Sep 20, 2023
- Beds
- 13
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 7, 2003 in IL
- Enrollment address
- 875 S. Route 31
Crystal Lake, IL 60014-8190 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Dave L Syverson |
Corporate Director |
Nov 8, 1999 | |
| Kathi J Palches |
W-2 Managing Employee |
Nov 8, 1999 | |
| Ali Olia |
Corporate Officer |
Nov 1, 2021 | |
| Kara Sankey |
Corporate Officer |
Apr 1, 2021 | |
| Jennifer a Hallatt |
Corporate Officer |
Jan 1, 2012 | |
| Carlos Arevalo |
Corporate Director |
Oct 16, 2024 | |
| Mercy Health Corporation |
5% Or Greater Indirect Ownership Interest | Jan 1, 2015 | 100% |
| Thomas D Budd |
Corporate Director |
Nov 8, 1999 | |
| John T Dorsey |
Corporate Officer |
Aug 20, 2012 | |
| W-2 Managing Employee |
Jul 23, 2023 | ||
| Katherine a Schack |
Corporate Director |
Jan 1, 2016 | |
| Joseph Malas |
Corporate Officer |
Jun 1, 2025 | |
| W-2 Managing Employee |
Jun 1, 2025 | ||
| Joanna Benning |
Corporate Officer |
Mar 15, 2015 | |
| Robert Brinkerhoff |
Corporate Officer |
Feb 19, 2024 | |
| Edward P Cranley |
Corporate Officer |
Nov 30, 2014 | |
| Bradley Olson |
Corporate Officer |
Sep 25, 2023 | |
| Mark L Goelzer |
Corporate Officer |
Jan 1, 2016 | |
| Corporate Director |
Jan 1, 2016 | ||
| Kimberly Scaccia |
Corporate Officer |
Mar 23, 2020 | |
| Wesley M Jost |
Corporate Director |
Nov 8, 1999 | |
| Tyler Killpack |
Corporate Officer |
Aug 1, 2023 | |
| W-2 Managing Employee |
Aug 1, 2023 | ||
| Amy Whitaker |
Corporate Officer |
Aug 1, 2022 | |
| Thomas R Pool |
Corporate Director |
Nov 8, 1999 | |
| Ladd Udy |
Corporate Officer |
Nov 10, 2018 | |
| Javon R Bea |
Corporate Officer |
Apr 28, 1982 | |
| Corporate Director |
Apr 28, 1982 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230814002220 | IL | Part a Provider - Hospital | 8628430295 | Practice locations: Crystal Lake, IL |
National Provider Directory
- Tax ID family
- Mercy Crystal Lake Hospital and Medical Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Yes |
Addresses
Primary practice location
875 S Route 31
Crystal Lake, IL 60014
Mailing address
875 S. Route 31
Crystal Lake, IL 60014
Phone (779) 220-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140308 | Other | IL | IL MEDICARE |
| 0006403 | Other | IL | IL STATE LICENSE |
Other names
- Mercyhealth Hospital and Physician Clinic-Crystal Lake
Other providers in Crystal Lake, IL
- Georgette Melus
- Alicia Ana Mendoza
- Michael A Menis
- Mental Health Connections, PLLC
- Muizz Merchant
- Mercy Crystal Lake Hospital and Medical Center Inc
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercy Heatlh System Corporation
All providers in Crystal Lake, IL · General Acute Care Hospital in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.