NPIMap

Organization Active NPI

Southern Illinois Medical Services, NFP

  • Rural Health Clinic/Center
  • Carbondale, IL
National Provider Identifier
1154510808
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Practice address
2601 W Main St
Carbondale, IL 62901-1031
Phone
(618) 549-5361
Fax
(618) 351-4878
NPI assigned
Oct 18, 2007
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 1

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

Addresses

Primary practice location

2601 W Main St
Carbondale, IL 62901-1031

Mailing address

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

Other names 1

  • Center for Medical Arts Rural Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080111000386 IL Part A Provider - Rural Health Clinic 3678677390 Practice locations: Carbondale, IL

Rural health clinic certification: CCN 143821

Legal name
SOUTHERN ILLINOIS MEDICAL SERVICES NFP
Doing business as
CENTER FOR MEDICAL ARTS RURAL HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 20, 1991
Last certification
Feb 19, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 30, 2006 in IL
Enrollment address
2601 W Main St
Carbondale, IL 62901-1031

Other NPIs with the same Medicare PAC ID 7

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

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
14D0436404Center for Medical Arts2601 W Main St, Carbondale, IL 62901Certificate of waiverMay 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Benton Community Healthcare7 organizations share this tax ID, including this one
Part of
Southern Il Hospital SVCS

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

305 W Jackson St
Ste 302
Carbondale, IL 62901
Phone (618) 457-3006

409 W Oak St
Ste 202
Carbondale, IL 62901
Phone (618) 295-0555

207 W Jackson St
Ste 104
Carbondale, IL 62901

305 W Jackson St
Ste 206
Carbondale, IL 62901
Phone (618) 457-3006

404 Lincoln Dr
Herrin, IL 62948
Phone (618) 993-0056

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 24, 2013
Robert L Mees Individual Corporate OfficerChair Jun 28, 2012
Kathleen B Fralish Individual Corporate DirectorBoard Member Nov 13, 2006
Southern Illinois Healthcare Enterprises Inc Organization, Carbondale, IL Non-profit 5% Or Greater Indirect Ownership Interest Dec 3, 2007 100%
Southern Illinois Hospital Services Organization, Carbondale, IL Non-profit 5% Or Greater Direct Ownership Interest Dec 3, 2007 100%
Operational/Managerial Control Dec 3, 2007 100%
Warren P Ladner Individual Corporate OfficerSVP & Cfo Feb 21, 2022
Operational/Managerial ControlSVP & Cfo Feb 21, 2022
George M O'Neill Individual Corporate DirectorBoard Member Nov 13, 2006
Debra L Braunling-McMorrow Individual Corporate OfficerVice Chair Sep 22, 2011
Daniel Booth Individual Corporate DirectorBoard Member Apr 1, 2020
W E Basanta Individual Corporate DirectorBoard Member Jan 26, 1995
Gina Sirach Individual Corporate DirectorBoard Member Mar 24, 2022
Brad Cole Individual Corporate DirectorBoard Member May 3, 2007
Michael P Tison Individual Corporate DirectorBoard Member Jul 22, 2021
Austin a Lane Individual Corporate DirectorBoard Member May 6, 2021
Steven R Sabens Individual Corporate DirectorBoard Member Mar 24, 2011
John D Antes Individual Corporate OfficerCeo Dec 12, 2022

Owners & managing parties with NPI records 6

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

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 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1154510808",
    "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": "2601 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-549-5361",
            "fax_number": "618-351-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS MEDICAL SERVICES, NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN ILLINOIS HOSPITAL SERVICES",
        "enumeration_date": "2007-10-18",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Medical Arts Rural Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.