NPIMap

Organization Active NPI

Southern Illinois Hospital Services

  • Family Medicine Physician
  • West Frankfort, IL
National Provider Identifier
1154408581
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTHERN ILLINOIS HOSPITAL SERVICES
Practice address
2553 Ken Gray Blvd
West Frankfort, IL 62896-4174
Phone
(618) 932-3937
Fax
(618) 932-2734
NPI assigned
Nov 1, 2006
Organization subpart
Yes
Parent organization
SOUTHERN ILLINOIS HOSPITAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Authorized official

Name
Warren P Ladner
Title
Senior VP Chief Financial Officer
Phone
(618) 457-5200

Specialties & licenses 2

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

Addresses

Primary practice location

2553 Ken Gray Blvd
West Frankfort, IL 62896-4174

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other names 1

  • West Frankfort Family Medicine 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
O20100622000692 IL Part A Provider - Rural Health Clinic 2961310966 Practice locations: West Frankfort, IL

Rural health clinic certification: CCN 143454

Legal name
SOUTHERN ILLINOIS HOSPITAL SERVICES
Doing business as
WEST FRANKFORT FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 1, 1999
Last certification
Oct 13, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 1946 in IL
Enrollment address
2553 Ken Gray Blvd
West Frankfort, IL 62896-4174
Related CCNs
140164

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.

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
14D0667250West Frankfort Family Medicine2553 Ken Gray Blvd, West Frankfort, IL 62896Certificate of waiverJul 4, 2028

National Provider Directory

National Provider Directory
Part of
Southern Il Hospital SVCS

Ownership & related parties

All disclosed owners & managing parties 14

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 Director Jun 1, 1990
Robert L Mees Individual Corporate DirectorBoard Member Chair Jun 28, 2012
Edna M Simpson Individual Corporate DirectorBoard Member Secretary Dec 1, 2004
Kathleen B Fralish Individual Corporate Director Jun 1, 1996
Warren P Ladner Individual Corporate OfficerSr.VP Cfo/Treasurer Feb 21, 2022
Corporate DirectorSr. VP Cfo/Treasurer Feb 21, 2022
George M O'Neill Individual Corporate Director May 1, 2002
Debra L Braunling-McMorrow Individual Corporate DirectorBoard Member Vice Chair Sep 1, 2011
Daniel Booth Individual Corporate Director Mar 26, 2020
W E Basanta Individual Corporate Director Jan 1, 1995
Michael P Tison Individual Corporate Director Jul 22, 2021
Austin a Lane Individual Corporate Director May 6, 2021
Steven R Sabens Individual Corporate Director May 1, 2002
Shannon S Hartke Individual W-2 Managing EmployeeCorporate Director PFS Mar 8, 2008
John D Antes Individual Corporate OfficerPresident & Ceo Dec 12, 2022
Corporate Director Dec 12, 2022
W-2 Managing Employee Dec 12, 2022

All facility ownership & control disclosures 17

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
Memorial Hospital of CarbondaleCarbondale, IL, CCN 140164 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 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1154408581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2553 KEN GRAY BLVD",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628964174",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HOSPITAL SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN ILLINOIS HOSPITAL SERVICES",
        "enumeration_date": "2006-11-01",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "LADNER",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SENIOR VP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "618-457-5200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Frankfort Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Frankfort Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Frankfort, IL

Sources for this page

Verify at the official NPI Registry.