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Organization Active NPI

Pana Community Hospital Association

Doing business as Community Medical Clinic of Pana

  • Rural Health Clinic/Center
  • Pana, IL
National Provider Identifier
1235225236
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Community Medical Clinic of Pana
Practice address
101 E 9TH St
Suite 105
Pana, IL 62557
Phone
(217) 562-2544
Fax
(217) 562-6288
NPI assigned
Oct 5, 2006
Last updated
Oct 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Authorized official

Name
Miss Lisa Marie Bloemer, CMC &CMIS
Title
Practice Manager
Phone
(217) 562-6257

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

101 E 9TH St
Suite 105
Pana, IL 62557

Mailing address

101 E 9TH St
Suite 105
Pana, IL 62557-1716
Phone (217) 562-2544

Other names 1

  • COMMUNITY MEDICAL CLINIC OF PANA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080114000652 IL Part A Provider - Rural Health Clinic 3274437348 Practice locations: Pana, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235225236. Details of each certification follow.

Rural health clinic certification: CCN 148508

Legal name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
COMMUNITY MEDICAL CLINIC OF PANA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 18, 2010
Last certification
May 17, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 8, 1966 in IL
Enrollment address
101E 9TH St
105
Pana, IL 62557-1716
Related CCNs
141341

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Pana Comm Hosp Respirat17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Locations

101 E 9th St
Ste 105
Pana, IL 62557
Phone (217) 562-2544

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
David Slater Individual Corporate Director May 1, 2017
Matt Beavers Individual Corporate Director May 1, 2013
James E Moon Individual Corporate Officer Jan 1, 2012
W-2 Managing EmployeeCfo Jan 1, 2012
Charles O'Malley Individual Corporate Director May 1, 2016
Larry Cearlock Individual Corporate Director May 1, 2015
Amanda Richards Individual Corporate Director May 1, 2018
Kenneth Flesch Individual Corporate Director May 1, 2017
Lisa M Bloemer Individual W-2 Managing Employee Jan 1, 2008
Jimmie Brewer Individual Corporate Director May 1, 2016
Katrina J Casner Individual Corporate Officer Jan 1, 2008
W-2 Managing EmployeePresident & Ceo Jan 1, 2008
Rick Schmitz Individual Corporate Director May 1, 2014
David R Lett Individual Corporate Director May 1, 2014
Gregory Holthaus Individual Corporate Director May 1, 2015
Walter H Cunnington Individual Corporate Director May 1, 2015

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Medical Clinic of NokomisNokomis, IL, CCN 148574 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 2016
Jul 19, 2022
Community Medical Clinic of AssumptionAssumption, IL, CCN 148575 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 1, 2016
Jul 19, 2022
Cowden Medical GroupCowden, IL, CCN 148637 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2022
Aug 1, 2022

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791244800000",
    "number": "1235225236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 9TH ST",
            "address_2": "SUITE 105",
            "city": "PANA",
            "state": "IL",
            "postal_code": "625571716",
            "telephone_number": "217-562-2544",
            "fax_number": "217-562-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E 9TH ST",
            "address_2": "SUITE 105",
            "city": "PANA",
            "state": "IL",
            "postal_code": "62557",
            "telephone_number": "217-562-2544",
            "fax_number": "217-562-6288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANA COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A",
        "authorized_official_last_name": "BLOEMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "217-562-6257",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "CMC &CMIS"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMMUNITY MEDICAL CLINIC OF PANA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COMMUNITY MEDICAL CLINIC OF PANA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pana, IL

Sources for this page

Verify at the official NPI Registry.