NPIMap

Organization Active NPI

Passavant Memorial Area Hospital Association

Doing business as Passavant Area Hospital

  • Critical Access Hospital
  • Jacksonville, IL
National Provider Identifier
1174580831
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Doing business as
Passavant Area Hospital
Practice address
1600 W Walnut St
Jacksonville, IL 62650
Phone
(217) 245-9541
Fax
(217) 479-8781
NPI assigned
Apr 27, 2006
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HEALTH SYSTEMSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Paul Eddington
Title
Cfo
Phone
(217) 479-5898

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0001792 IL
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

1600 W Walnut St
Jacksonville, IL 62650

Mailing address

1600 W Walnut St
Jacksonville, IL 62650-9980
Phone (217) 245-9541

Other names 1

  • Passavant Area Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210624003149 IL Part A Provider - Critical Access Hospital 3173503281 Receives reassigned benefits from 37 practitioners
Practice locations: Jacksonville, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1174580831. Details of each certification follow.

Hospital certification: CCN 141352

Legal name
PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Doing business as
JACKSONVILLE MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 26, 2022
Last certification
Apr 26, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1906 in IL
Enrollment address
1600 W Walnut St
Jacksonville, IL 62650-1136
Main/Primary Hospital Location

Hospital certification: CCN 140058

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
JACKSONVILLE MEMORIAL HOSPITAL
Certification status
Terminated Other: provider status change, Apr 26, 2022
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 21, 2017
Beds
116
Ownership / control type
Private (not for profit)
Facility address
1600 W Walnut St
Jacksonville, IL 62650

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Jacksonville Memorial HospitalCCN 141352 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Thomas Veith Individual Corporate DirectorBoard Member Jan 1, 2012
Lindsay McQueen Individual Corporate DirectorBoard Member Mar 1, 2025
Maryjane Bradbury Individual Corporate DirectorBoard Member Jan 1, 2019
Polly Pulley Individual Corporate DirectorBoard Member Oct 19, 2020
Stephen C Symons Individual Corporate DirectorBoard Member Jan 15, 2019
Bradley W Wilson Individual Corporate DirectorBoard Member Jan 15, 2019
Kim Andras Individual Corporate DirectorBoard Member Jan 1, 2022
Paul R Eddington Individual Corporate DirectorDirector Strategic Finance Jun 1, 2023
W-2 Managing EmployeeDirector Strategic Finance Oct 24, 2005
Michael T Huffman Individual Corporate OfficerPresident & Ceo Feb 24, 2023
Memorial Health System Organization, Springfield, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2014 100%
Kelly Staake Individual Corporate DirectorBoard Member Jan 1, 2013
Gary Westermeyer Individual Corporate DirectorBoard Member Mar 1, 2025
James E Hinchen Individual Corporate DirectorBoard Member Jan 1, 2014
Elias Daniel Trace Individual Corporate DirectorBoard Member Mar 1, 2025
Reginald H Benton Individual Corporate DirectorBoard Member Jan 1, 2011
Stephanie Seaman Individual W-2 Managing EmployeeProvider Enrollment Coordinator Feb 3, 2014
Barbara a Farley Individual Corporate DirectorBoard Member Oct 19, 2015
Timothy Greene Individual Corporate DirectorBoard Member Mar 1, 2025
Peter D Russotto Individual Corporate DirectorBoard Member Jan 16, 2018

Owners & managing parties with NPI records 1

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

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

Affiliated clinicians 234

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 234

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1174580831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626509980",
            "telephone_number": "217-245-9541",
            "fax_number": "217-479-8781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "62650",
            "telephone_number": "217-245-9541",
            "fax_number": "217-479-8781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HEALTH SYSTEMS",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "EDDINGTON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "217-479-5898"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0001792",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Passavant Area Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Passavant Area Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, IL

Sources for this page

Verify at the official NPI Registry.