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Organization Active NPI

Southern Illinois Hospital Services

Doing business as Memorial Hospital of Carbondale

  • General Acute Care Hospital
  • Carbondale, IL
National Provider Identifier
1093801797
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0000513 Issued in IL
Legal business name
SOUTHERN ILLINOIS HOSPITAL SERVICES
Doing business as
Memorial Hospital of Carbondale
Practice address
405 W Jackson
Carbondale, IL 62901-1000
Phone
(618) 457-5200
NPI assigned
Oct 4, 2006
Last updated
Aug 18, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

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

Authorized official

Name
Shannon Hartke
Title
Corporate Director, Patient Financi
Phone
(618) 457-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0000513 IL Primary

Addresses

Primary practice location

405 W Jackson
Carbondale, IL 62901-1000

Mailing address

1239 E Main St
Carbondale, IL 62901-3175
Phone (618) 457-5200

Other identifiers 1

IdentifierTypeStateIssuer
0000513OtherILSTATE OF IL LICENSE NUMBE

Other names 1

  • Memorial Hospital of Carbondale Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031211000718 IL Part B Supplier - Clinic/Group Practice 2961310966 Receives reassigned benefits from 35 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Murphysboro, IL; West Frankfort, IL; W Frankfort, IL; Herrin, IL; Harrisburg, IL; Carbondale, IL; Benton, IL
O20071117000076 IL Part A Provider - Hospital 2961310966 Practice locations: Anna, IL; Carbondale, IL; Carterville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093801797. Details of each certification follow.

Hospital certification: CCN 140164

Legal name
SOUTHERN ILLINOIS HOSPITAL SERVICES
Doing business as
MEMORIAL HOSPITAL OF CARBONDALE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 20, 2013
Beds
140
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1975 in IL
Enrollment address
405 W Jackson St
Carbondale, IL 62901-1462
Other Hospital Practice Location
Hospital subgroups
General

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital of CarbondaleCCN 140164 · All quality measures
Overall star rating
1 of 5
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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Morton P Levine Individual Corporate DirectorBoard Member Jun 21, 1990
Robert L Mees Individual Corporate DirectorChair - Board Member Jun 28, 2012
Edna M Simpson Individual Corporate DirectorSecretary - Board Member Nov 11, 2004
Kathleen B Fralish Individual Corporate DirectorBoard Member Mar 28, 1996
Southern Illinois Healthcare Enterprises Inc Organization, Carbondale, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 6, 1983 100%
Southern Illinois Hospital Services Organization, Carbondale, IL Corporation, Non-profit Operational/Managerial Control Nov 12, 2007 100%
Warren P Ladner Individual Corporate DirectorSr. VP Cfo/Treasurer Feb 21, 2022
W-2 Managing EmployeeSr. VP Cfo/Treasurer Feb 21, 2022
George M O'Neill Individual Corporate DirectorBoard Member Mar 21, 2002
Debra L Braunling-McMorrow Individual Corporate DirectorBoard Member Sep 22, 2011
Daniel Booth Individual Corporate Director Mar 26, 2020
W E Basanta Individual Corporate DirectorBoard Member Jan 26, 1995
Michael P Tison Individual Corporate Director Jul 22, 2021
Austin a Lane Individual Corporate Director May 6, 2021
Steven R Sabens Individual Corporate DirectorBoard Member Mar 21, 2002
Shannon S Hartke Individual W-2 Managing EmployeeCorporate Director PFS Mar 8, 2008
John D Antes Individual Corporate DirectorPresident & Ceo Dec 12, 2022
W-2 Managing EmployeePresident & Ceo Dec 12, 2022

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 16

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Joseph Memorial HospitalMurphysboro, IL, CCN 141334 Hospital Operational/Managerial Control (100%) Nov 12, 2007
Herrin HospitalHerrin, IL, CCN 140011 Hospital Operational/Managerial Control (100%) Nov 12, 2007
Herrin HospitalHerrin, IL, CCN 14T011 Hospital Operational/Managerial Control (100%) Apr 1, 1998
Harrisburg Medical Center IncHarrisburg, IL, CCN 140210 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2021
Harrisburg Medical CenterHarrisburg, IL, CCN 14S210 Hospital 5% Or Greater Direct Ownership Interest Aug 1, 2021
Harrisburg Medical CenterHarrisburg, IL, CCN 14U210 Hospital 5% Or Greater Direct Ownership Interest Aug 1, 2021
St Joseph Memorial HospitalMurphysboro, IL, CCN 14Z334 Hospital Operational/Managerial Control Nov 14, 2013
Center for Medical Arts Rural HealthCarbondale, IL, CCN 143821 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 3, 2007
Dec 3, 2007
Eldorado Primary CareEldorado, IL, CCN 143473 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2021
Medical Arts ClinicMurphysboro, IL, CCN 143871 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 2009
Nov 1, 2009
Sih Medical Group at Benton Community HealthcareBenton, IL, CCN 783821 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 23, 2011
Logan Primary CareHerrin, IL, CCN 143870 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2011
Nov 1, 2011
Logan Primary Care ServiceWest Frankfort, IL, CCN 148969 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2011
Nov 1, 2011
Primary Care GroupHarrisburg, IL, CCN 143883 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2014
Feb 1, 2014
Sih Medical Group Anna Primary CareAnna, IL, CCN 783847 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 3, 2017
Harrisburg Medical CenterMarion, IL, CCN 148590 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2021

Owned or controlled facilities with NPI records 16

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 16

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 7

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 588

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

View all 588

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787011200000",
    "number": "1093801797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 E MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013175",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W JACKSON",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011000",
            "telephone_number": "618-457-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HOSPITAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A",
        "authorized_official_last_name": "HARTKE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CORPORATE DIRECTOR, PATIENT FINANCI",
        "authorized_official_telephone_number": "618-457-5200"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0000513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF IL LICENSE NUMBE",
            "identifier": "0000513",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Hospital of Carbondale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.