NPIMap

Organization Active NPI

Methodist Medical Center of Illinois

Doing business as Carle Health Lacon

  • Rural Health Clinic/Center
  • Lacon, IL
National Provider Identifier
1073484929
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
METHODIST MEDICAL CENTER OF ILLINOIS
Doing business as
Carle Health Lacon
Practice address
1112 5TH St
Lacon, IL 61540-1353
Phone
(309) 246-2416
Fax
(309) 246-3574
NPI assigned
Sep 15, 2025
Last updated
Sep 15, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THE CARLE FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Aron Klein
Title
VP Finance
Phone
(309) 268-2410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

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 1

  • CARLE HEALTH LACON Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251023003171 IL Part A Provider - Rural Health Clinic 1355259714 Practice locations: Lacon, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073484929. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
1112 5TH St
Lacon, IL 61540-1353
Related CCNs
140209

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Terry L Waters Individual Corporate DirectorBoard Member Jan 1, 2024
Dennis R Triggs Individual Corporate DirectorBoard Member Nov 1, 2013
Melissa Yoder Individual Corporate DirectorBoard Member Jan 1, 2022
Keila Sierra-Cintron Individual Corporate DirectorBoard Member Jan 1, 2024
Deveraux Hubbard Individual Corporate DirectorBoard Member Jan 1, 2025
Aron T Klein Individual Corporate OfficerSVP Financial Operations Feb 25, 2025
W-2 Managing EmployeeSVP Financial Operations Feb 25, 2025
Rich R Kriegsman Individual Corporate DirectorBoard Member Jun 1, 2020
Brandon Moss Individual Corporate DirectorBoard Member Jan 1, 2025
Becki Salmon Individual Corporate DirectorBoard Member Jan 1, 2025
Jeanine Spain Individual Corporate DirectorBoard Member Jan 1, 2025
Deborah R Simon Individual Corporate DirectorBoard Member Jan 1, 2023
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Apr 1, 2023 100%
Matthew Craig Kolb Individual Corporate DirectorBoard Member Apr 1, 2023
Keith Knepp Individual Corporate OfficerRegional Ceo Jan 1, 2019
Dirk W Roecker Individual Corporate DirectorBoard Member Jan 1, 2017
Luke J Sullivan Individual Corporate OfficerVP Finance Aug 1, 2025
W-2 Managing EmployeeVP Finance Aug 1, 2025
Aaron Kilgore Individual Corporate DirectorBoard Member Jun 1, 2017
James D Stevenson Individual Corporate DirectorBoard Member Jun 1, 2012
Jeffrey Leman Individual Corporate DirectorBoard Member Jan 1, 2024
Kevin Barbier Individual Corporate DirectorBoard Member Jun 1, 2016

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 31

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

View all 31

Change-of-ownership history 1

DateEventCounterparty
Dec 1, 2025 Change of OwnershipThis provider was the buyer Carle Health LaconCCN 783807, IL, NPI 1477269421

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1757894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1073484929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "address_2": "GOMP100",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360001",
            "telephone_number": "309-672-4874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 5TH ST",
            "city": "LACON",
            "state": "IL",
            "postal_code": "615401353",
            "telephone_number": "309-246-2416",
            "fax_number": "309-246-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MEDICAL CENTER OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CARLE FOUNDATION",
        "enumeration_date": "2025-09-15",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "ARON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "309-268-2410"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARLE HEALTH LACON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lacon, IL

Sources for this page

Verify at the official NPI Registry.