NPIMap

Organization Active NPI

Graham Hospital Association

  • Rural Health Clinic/Center
  • Glasford, IL
National Provider Identifier
1104604529
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRAHAM HOSPITAL ASSOCIATION
Practice address
201 E Main St
Glasford, IL 61533
Phone
(309) 647-0201
NPI assigned
Sep 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Authorized official

Name
Mrs. Julie Reeder
Title
VP of Finance and Cfo
Phone
(309) 647-5240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

201 E Main St
Glasford, IL 61533

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Other names 1

  • Graham Medical Group Glasford Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040510000873 IL Part B Supplier - Clinic/Group Practice 2769375021 Receives reassigned benefits from 139 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesburg, IL; Williamsfield, IL; Macomb, IL; Lewistown, IL; Glasford, IL; Farmington, IL; Elmwood, IL; Canton, IL
O20231107001296 IL Part A Provider - Rural Health Clinic 2769375021 Practice locations: Glasford, IL

Rural health clinic certification: CCN 148672

Legal name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
GRAHAM MEDICAL GROUP-GLASFORD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 2024
Last certification
Nov 19, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1905 in IL
Enrollment address
201 E Main St
Glasford, IL 61533
Related CCNs
140001

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Graham Hospital Association22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Allison Sours Individual Corporate OfficerPresident and Ceo Jan 5, 2026
W-2 Managing EmployeePresident & Ceo Jan 5, 2026
Operational/Managerial ControlPresident & Ceo Jan 5, 2026
William Carlberg Individual Corporate Director Jan 1, 2022
Kenneth Krock Individual Corporate Director Jan 1, 2021
Terry Moss Individual Corporate Director Jan 1, 2021
Janis Blout Individual Corporate Director Jan 1, 2019
Erin Elizabeth Bailey Individual Corporate Director Jun 1, 2023
Kevin Meade Individual Corporate Director Jan 1, 2020
Sarah Keefer Individual Corporate DirectorBoard Member Jul 1, 2025
Julie Reeder Individual Corporate OfficerCfo Mar 6, 2017
W-2 Managing Employee Mar 6, 2017
Operational/Managerial Control Mar 6, 2017

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1104604529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E MAIN ST",
            "city": "GLASFORD",
            "state": "IL",
            "postal_code": "61533",
            "telephone_number": "309-647-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "REEDER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP OF FINANCE AND CFO",
        "authorized_official_telephone_number": "309-647-5240",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graham Medical Group Glasford",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Graham Medical Group Glasford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glasford, IL

Sources for this page

Verify at the official NPI Registry.