NPIMap

Organization Active NPI

Ahearn & Associates Medical Center, Inc

  • Rural Health Clinic/Center
  • Kewanee, IL
National Provider Identifier
1114036308
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AHEARN & ASSOCIATES MEDICAL CENTER, INC
Practice address
513 Elliott St
Suite 4
Kewanee, IL 61443-2797
Phone
(309) 853-2442
Fax
(309) 853-2435
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Michael A Ahearn, M.D.NPI 1184687717
Title
M.D.
Phone
(309) 853-2442

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X IL
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

513 Elliott St
Suite 4
Kewanee, IL 61443-2797

Mailing address

519 Elliott St Ste S1
Kewanee, IL 61443-2776
Phone (309) 853-2442

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL 3098532435 Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311000015 IL Part B Supplier - Clinic/Group Practice 0244129195 Receives reassigned benefits from 7 practitioners
Practice locations: Kewanee, IL
O20060110000153 IL Part A Provider - Rural Health Clinic 0244129195 Practice locations: Kewanee, IL

Rural health clinic certification: CCN 148985

Legal name
AHEARN & ASSOCIATES MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 20, 2006
Last certification
Jan 24, 2025
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 25, 2003 in IL
Enrollment address
519 Elliott St
S1
Kewanee, IL 61443-2776

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1014048Ahearn & Associates Medical Center519 Elliott Street, Suite 1, Kewanee, IL 61443Certificate of waiverJun 23, 2027

National Provider Directory

National Provider Directory

Locations

1242 E Empire St
Ste 3
Bloomington, IL 61701
Phone (309) 820-8861

519 Elliott St
Ste S1
Kewanee, IL 61443
Phone (309) 853-2442

7301 34th Ave
Moline, IL 61265
Phone (309) 796-2949

767 30th St
Rock Island, IL 61201
Phone (309) 788-7631

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5670/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Michael Ahearn Individual 5% Or Greater Direct Ownership Interest Jul 1, 2003
Corporate Director Jan 10, 2006
W-2 Managing Employee Jul 1, 2003

Owners & managing parties with NPI records 1

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

  • Michael A Ahearn, MD
    • Family Medicine Physician
    • Kewanee, IL
    • NPI 1184687717

    5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 7

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1114036308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 ELLIOTT ST STE S1",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614432776",
            "telephone_number": "309-853-2442",
            "fax_number": "309-853-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 ELLIOTT ST",
            "address_2": "SUITE 4",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614432797",
            "telephone_number": "309-853-2442",
            "fax_number": "309-853-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AHEARN & ASSOCIATES MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-07-21",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "AHEARN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "309-853-2442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "3098532435",
            "affiliation": "N",
            "endpointDescription": "3098532435",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "513 Elliott St",
            "address_2": "Suite 4",
            "city": "Kewanee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "614432797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kewanee, IL

Sources for this page

Verify at the official NPI Registry.