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Organization Active NPI

Mercy Crystal Lake Hospital and Medical Center Inc

Doing business as Mercyhealth Hospital and Physician Clinic-Crystal Lake

  • General Acute Care Hospital
  • Crystal Lake, IL
National Provider Identifier
1023754371
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC
Doing business as
Mercyhealth Hospital and Physician Clinic-Crystal Lake
Practice address
875 S Route 31
Crystal Lake, IL 60014
Phone
(608) 756-6080
Fax
(608) 756-6236
NPI assigned
May 10, 2022
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patricia Lynne Allen
Title
Cfo
Phone
(608) 756-6080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

875 S Route 31
Crystal Lake, IL 60014

Mailing address

875 S. Route 31
Crystal Lake, IL 60014-8190
Phone (779) 220-5500

Other names 1

  • Mercyhealth Hospital and Physician Clinic-Crystal Lake Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230814002220 IL Part A Provider - Hospital 8628430295 Practice locations: Crystal Lake, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023754371. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jul 7, 2003 in IL
Enrollment address
875 S. Route 31
Crystal Lake, IL 60014-8190
Main/Primary Hospital Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercyhealth Hospital & Physician Clinic-Crystal laCCN 140308 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Mercy Crystal Lake Hospital and Medical Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dave L Syverson Individual Corporate DirectorBoard Member Nov 8, 1999
Kathi J Palches Individual W-2 Managing EmployeeFacility Credentialing Nov 8, 1999
Ali Olia Individual Corporate OfficerVP Information Systems Nov 1, 2021
Kara Sankey Individual Corporate OfficerVP Operations Apr 1, 2021
Jennifer a Hallatt Individual Corporate OfficerVP Operations Jan 1, 2012
Carlos Arevalo Individual Corporate DirectorBoard Member Oct 16, 2024
Mercy Health Corporation Organization, Rockford, IL Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2015 100%
Thomas D Budd Individual Corporate DirectorBoard Secretary/Treasurer Nov 8, 1999
John T Dorsey Individual Corporate OfficerVP Medical Staff Affairs Aug 20, 2012
W-2 Managing EmployeeMD; Jul 23, 2023
Katherine a Schack Individual Corporate DirectorBoard Member Jan 1, 2016
Joseph Malas Individual Corporate OfficerCfo Jun 1, 2025
W-2 Managing EmployeeCfo Jun 1, 2025
Joanna Benning Individual Corporate OfficerVP Operations Mar 15, 2015
Robert Brinkerhoff Individual Corporate OfficerVP People & Culture Feb 19, 2024
Edward P Cranley Individual Corporate OfficerVP Operations Mercycare Insurance Nov 30, 2014
Bradley Olson Individual Corporate OfficerVP Managed Care Sep 25, 2023
Mark L Goelzer Individual Corporate OfficerVP Medical Staff Affairs Jan 1, 2016
Corporate DirectorDirector of Medical Staff Affairs Jan 1, 2016
Kimberly Scaccia Individual Corporate OfficerVP Revenue Cycle Mar 23, 2020
Wesley M Jost Individual Corporate DirectorBoard Member Nov 8, 1999
Tyler Killpack Individual Corporate OfficerVP Community Hospitals Aug 1, 2023
W-2 Managing EmployeeAd; Aug 1, 2023
Amy Whitaker Individual Corporate OfficerVP Supply Chain Aug 1, 2022
Thomas R Pool Individual Corporate DirectorBoard Vice Chair Nov 8, 1999
Ladd Udy Individual Corporate OfficerVP Value Based Care Nov 10, 2018
Javon R Bea Individual Corporate OfficerPresident and Ceo Apr 28, 1982
Corporate DirectorPresident and Ceo Apr 28, 1982

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 134

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 134

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1023754371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 S. ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148190",
            "telephone_number": "779-220-5500",
            "fax_number": "779-220-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "608-756-6080",
            "fax_number": "608-756-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HEALTH CORPORATION",
        "enumeration_date": "2022-05-10",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "608-756-6080"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercyhealth Hospital and Physician Clinic-Crystal Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.