NPIMap

Organization Active NPI

American Healthcare Systems Illinois LLC

Doing business as Gateway Regional Medical Center

  • Psychiatric Hospital Unit
  • Granite City, IL
National Provider Identifier
1043918576
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC
Doing business as
Gateway Regional Medical Center
Practice address
2100 Madison Ave
Granite City, IL 62040-4713
Phone
(618) 798-3000
NPI assigned
Feb 23, 2023
Last updated
Feb 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Authorized official

Name
Jonathan Burket
Title
Compliance
Phone
(818) 666-0602

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

2100 Madison Ave
Granite City, IL 62040-4713

Mailing address

2100 Madison Ave
Granite City, IL 62040-4713

Other names 1

  • Gateway Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230517000286 IL Part A Provider - Hospital 2769857481 Practice locations: Granite City, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043918576. Details of each certification follow.

Hospital certification: CCN 14S125

Legal name
AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC
Doing business as
GATEWAY REGIONAL MEDICAL CENTER
Organization structure
LLCProprietary
Enrollment address
2100 Madison Ave
Granite City, IL 62040-4713
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
American Healthcare Systems Illinois LLC3 organizations share this tax ID, including this one
Part of
American Healthcare Systems Illinois LLC

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1261 University Dr
Ste B
Edwardsville, IL 62025
Phone (618) 659-9520

4802 S State Route 159
Fl 2
Glen Carbon, IL 62034
Phone (618) 798-3400

509 Hamacher St
Ste 300
Waterloo, IL 62298
Phone (614) 939-9790

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
American Healthcare Systems Corp Inc Organization, Glendale, CA Corporation, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2023 100%
Jonathan E Burket Individual Corporate OfficerCco Mar 1, 2023
W-2 Managing EmployeeCco Mar 1, 2023
Operational/Managerial ControlCco Mar 1, 2023
Plan Fam TR Organization, Los Angeles, CA 5% Or Greater Indirect Ownership Interest Mar 1, 2023 49%
Mike M Sarian Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2023 49%

Facilities with the same owner 5

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1043918576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404713",
            "telephone_number": "618-798-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "BURKET",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "COMPLIANCE",
        "authorized_official_telephone_number": "818-666-0602"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.