Methodist Medical Center of Illinois
Organization Active NPI Rural Health Clinic/Center · Lacon, IL
NPI 1073484929 · NPPES record last updated Sep 15, 2025
Key facts
- NPI
- 1073484929
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- METHODIST MEDICAL CENTER OF ILLINOIS
- Practice address
- 1112 5TH St
Lacon, IL 61540-1353 - Phone
- (309) 246-2416
- Fax
- (309) 246-3574
- NPI assigned
- Sep 15, 2025
- Organization subpart
- Yes
- Parent organization (as reported)
- THE CARLE FOUNDATION
Authorized official
- Name
- Aron Klein
- Title
- VP Finance
- Phone
- (309) 268-2410
Owners & managing parties with NPI records 2
-
Jeffrey S. Leman, MD
-
Keila M Sierra Cintron, M.D.
Other NPIs with the same Medicare PAC ID 7
Related certifications (CCN) 1
Change of ownership 1
Facilities with the same owner 31
Practitioners 387
-
Ayla Adams, PA-C
-
Kelly Ann Adcock, BSN MSN APN
-
Alexander Adler, MD
-
Kapil Kiran Aedma, M.D
-
Mansoor Ahmad, M.D
-
Mohsina Ahmed, M.D.
-
Chelsi E Al-Khenaizi, CRNA
-
Robert Andrew Allison, PA-C
-
Jamaluddin F Amanullah, M.D.
-
Rizwan Amin, MD
-
Richard Anderson, M.D.
-
Melanie Andrews, MD
-
Sydney Arnold, CRNA
-
Muaz Nizar Assaf, MD
-
Kaylee Atria, LCSW
-
Pratap Attaluri, MD
-
Amber N Avila, MD
-
Moaviz Badshah, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Rural health clinic certification: CCN 148682
- Legal name
- METHODIST MEDICAL CENTER OF ILLINOIS
- Doing business as
- CARLE HEALTH LACON
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 1, 2025
- Last certification
- Dec 29, 2021
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1112 5TH St
Lacon, IL 61540-1353 - Related CCNs
- 140209
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Terry L Waters |
Corporate Director |
Jan 1, 2024 | |
| Dennis R Triggs |
Corporate Director |
Nov 1, 2013 | |
| Melissa Yoder |
Corporate Director |
Jan 1, 2022 | |
| Keila Sierra-Cintron |
Corporate Director |
Jan 1, 2024 | |
| Deveraux Hubbard |
Corporate Director |
Jan 1, 2025 | |
| Aron T Klein |
Corporate Officer |
Feb 25, 2025 | |
| W-2 Managing Employee |
Feb 25, 2025 | ||
| Rich R Kriegsman |
Corporate Director |
Jun 1, 2020 | |
| Brandon Moss |
Corporate Director |
Jan 1, 2025 | |
| Becki Salmon |
Corporate Director |
Jan 1, 2025 | |
| Jeanine Spain |
Corporate Director |
Jan 1, 2025 | |
| Deborah R Simon |
Corporate Director |
Jan 1, 2023 | |
| The Carle Foundation |
5% Or Greater Direct Ownership Interest | Apr 1, 2023 | 100% |
| Matthew Craig Kolb |
Corporate Director |
Apr 1, 2023 | |
| Keith Knepp |
Corporate Officer |
Jan 1, 2019 | |
| Dirk W Roecker |
Corporate Director |
Jan 1, 2017 | |
| Luke J Sullivan |
Corporate Officer |
Aug 1, 2025 | |
| W-2 Managing Employee |
Aug 1, 2025 | ||
| Aaron Kilgore |
Corporate Director |
Jun 1, 2017 | |
| James D Stevenson |
Corporate Director |
Jun 1, 2012 | |
| Jeffrey Leman |
Corporate Director |
Jan 1, 2024 | |
| Kevin Barbier |
Corporate Director |
Jun 1, 2016 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Dec 1, 2025 | Change of Ownership |
Carle Health Lacon |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251023003171 | IL | Part a Provider - Rural Health Clinic | 1355259714 | Practice locations: Lacon, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1112 5TH St
Lacon, IL 61540-1353
Mailing address
221 NE Glen Oak Ave
Gomp100
Peoria, IL 61636-0001
Phone (309) 672-4874
Other names
- CARLE HEALTH LACON
Other providers in Lacon, IL
- John J Geiser O.D.
- Lacon Rehab and Nursing LLC
- Lacon Sparland Emergency 52
- Marshall County Health Department
- Beth Ann McKee
- Methodist Medical Center of Illinois
- Midland Community Unit 7
- Niri Corp
- North Central Behavioral Health Systems, Inc
- Tracy Jo Parsh
All providers in Lacon, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.