Ottawa Regional Hospital & Healthcare Center
Organization Active NPI Rural Health Clinic/Center · Ottawa, IL
NPI 1154048833 · NPPES record last updated Mar 7, 2024
Key facts
- NPI
- 1154048833
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER
- Practice address
- 1640 1St Ave
Ottawa, IL 61350-9214 - Phone
- (815) 431-9208
- NPI assigned
- Oct 24, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- OSF HEALTHCARE SYSTEM
Authorized official
- Name
- Robert C Sehring
- Title
- Ceo
- Phone
- (309) 655-2850
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 8
Related certifications (CCN) 1
Facilities with the same owner 76
Practitioners 47
-
Tasha Marie Arteaga, APRN
-
Beth Anne Aussem, LCPC
-
Jamie Bond, FNP
-
Laura Anne Cartwright, LCSW
-
Joseph W Chuprevich, D.O.
-
Ami M Dose, APRN, FNP
-
Ashley Gallick-Sokol, PMHNP-BC
-
Gueorgui S Gueorguiev, M.D.
-
Raul V Guerrero, MD
-
Patricia A Hess, NP
-
Madison Hester, APRN
-
Alisha Jackson, FNP
-
Jordan Joynt, FNP
-
Maria Khattak, M.D.
-
Vaughn Douglas Klaassen, LCPC
-
Edward Koo, DO
-
Laura L Kula, L.C.S.W.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2106691 | Osf Healthcare -Medical Group - Ottawa South | Certificate of waiver | Dec 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Rural health clinic certification: CCN 148652
- Legal name
- OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER
- Doing business as
- OSF HEALTHCARE - MEDICAL GROUP - OTTAWA SOUTH
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 2, 2023
- Last certification
- Mar 2, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 2, 1880 in IL
- Enrollment address
- 1640 1St Ave
Ottawa, IL 61350-9214 - Related CCNs
- 140110
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia a Brazeau |
Corporate Officer | Oct 1, 2006 | |
| Corporate Director | Oct 1, 2006 | ||
| Dawn C Trompeter |
Contracted Managing Employee |
Jan 1, 2019 | |
| Operational/Managerial Control |
Jan 1, 2019 | ||
| Anne M Ziegler |
Corporate Director | Jan 1, 2021 | |
| Melanie R Mann |
Corporate Officer | Oct 6, 2024 | |
| Corporate Director | Oct 1, 2006 | ||
| August Querciagrossa |
Contracted Managing Employee | Aug 17, 2022 | |
| Operational/Managerial Control | Aug 17, 2022 | ||
| Gerald J McShane |
Corporate Director | Sep 1, 1996 | |
| Osf Healthcare Ministries |
Operational/Managerial Control | Nov 1, 2024 | |
| Kathleen F Williams |
Corporate Officer | Nov 1, 2014 | |
| Corporate Director | Jan 1, 2003 | ||
| Kirsten M Largent |
Contracted Managing Employee |
Nov 8, 2024 | |
| Corporate Officer | Nov 8, 2024 | ||
| Operational/Managerial Control |
Nov 8, 2024 | ||
| Osf Healthcare System |
Operational/Managerial Control | Apr 30, 2012 | |
| Robert C Sehring |
Contracted Managing Employee |
Oct 20, 2017 | |
| Corporate Officer | Oct 20, 2017 | ||
| Corporate Director | Oct 20, 2017 | ||
| Operational/Managerial Control |
Oct 20, 2017 | ||
| Judith a Duvall |
Corporate Officer | Oct 1, 2006 | |
| Corporate Director | Oct 1, 1989 | ||
| Ushasri Koganti |
Contracted Managing Employee |
Dec 1, 2022 | |
| Operational/Managerial Control |
Dec 1, 2022 | ||
| Carisa a Neumann |
Corporate Director | Jan 1, 2021 | |
| Diane Zimmerman |
Contracted Managing Employee |
Dec 1, 2022 | |
| Operational/Managerial Control |
Dec 1, 2022 | ||
| Brian J Silverstein |
Corporate Director | Oct 1, 2015 | |
| Paula K Selamat |
Corporate Director | Oct 6, 2024 | |
| Bridget J Meidl |
Corporate Director | Nov 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221116002318 | IL | Part a Provider - Rural Health Clinic | 9133029861 | Practice locations: Ottawa, IL |
National Provider Directory
- Tax ID family
- Comm Hospital of Ottawa
- Part of
- Eastland Med Plaza Surg
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1640 1St Ave
Ottawa, IL 61350-9214
Mailing address
124 SW Adams St
Peoria, IL 61602-1308
Phone (309) 655-2850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999 | Medicaid | IL |
Other names
- OSF Healthcare - Medical Group - Ottawa South
Other providers in Ottawa, IL
- Ottawa Medical Center, PC
- Ottawa Osteopathic Physicians, LTD.
- Ottawa Pavilion, LTD.
- Ottawa Regional Cardinal Sleep Center, LLC
- Ottawa Regional DME LLC
- Ottawa Regional Hospital & Healthcare Center
- Ottawa Regional Hospital & Healthcare Center
- Ottawa Regional Hospital & Healthcare Center
- Ottawa Regional Hospital & Healthcare Center
- Ottawa Regional Hospital & Healthcare Center
All providers in Ottawa, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.