NPIMap

Organization Active NPI

Memorial Hospital Association

Doing business as Memorial Hospital

  • Critical Access Hospital
  • Carthage, IL
National Provider Identifier
1073858262
Registry record updated Apr 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0005611 Issued in IL
Legal business name
MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Memorial Hospital
Practice address
1454 N County Road 2050
Carthage, IL 62321-3551
Phone
(217) 357-8500
Fax
(217) 357-8564
NPI assigned
Nov 29, 2012
Last updated
Apr 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2019

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

Authorized official

Name
Mrs. Ada Bair
Title
Ceo
Phone
(217) 357-8566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0005611 IL Primary

Addresses

Primary practice location

1454 N County Road 2050
Carthage, IL 62321-3551

Mailing address

PO Box 160
Carthage, IL 62321-0160
Phone (217) 357-8500

Other names 1

  • Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121211000439 IL Part A Provider - Critical Access Hospital 0244134682 1 other NPI on this enrollment
Practice locations: Carthage, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073858262. Details of each certification follow.

Hospital certification: CCN 14Z305

Legal name
MEMORIAL HOSPITAL ASSOCIATION
Doing business as
MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 26, 1947 in IL
Enrollment address
1454 N County Road 2050
Carthage, IL 62321-3551
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosptl Association9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

630 Locust St
Ste A
Carthage, IL 62321

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Luann S Haas Individual Corporate DirectorHospital/Senior Services VP Apr 30, 2017
Teresa L Smith Individual Corporate OfficerCfo Dec 12, 2005
W-2 Managing Employee Dec 12, 2005
Karen Araya Individual Corporate Director Oct 29, 2024
Matthew Dickinson Individual Corporate Director Apr 1, 2025
Ada M Bair Individual Corporate OfficerCeo Nov 6, 2003
Patricia Schou Individual Corporate Director Oct 29, 2024
Douglas D Groth Individual Corporate DirectorPresident Mar 1, 2017
Brenda Young Individual Corporate DirectorBoard Member Sep 30, 2020
Stuart Froman Individual Corporate Director Oct 22, 2025
Matthew Kraus Individual Corporate Director Oct 22, 2025
Jami Hocker Individual Corporate Director Mar 27, 2024
Victora L Kalivoda-Popela Individual Corporate Director Sep 30, 2022
Terry a Pope Individual Corporate DirectorBoard Member Sep 1, 2013
Jennifer Roberts Individual Corporate Director Oct 22, 2025
Dan E Asbury Individual Corporate Director Sep 1, 2015

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1073858262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623210160",
            "telephone_number": "217-357-8500",
            "fax_number": "217-357-8564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 N COUNTY ROAD 2050",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623213551",
            "telephone_number": "217-357-8500",
            "fax_number": "217-357-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "BAIR",
        "authorized_official_first_name": "ADA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-357-8566",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0005611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carthage, IL

Sources for this page

Verify at the official NPI Registry.