NPIMap

Organization Active NPI

McDonough County Hospital District

  • Rural Health Clinic/Center
  • Macomb, IL
National Provider Identifier
1235755372
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Practice address
515 E Grant St Ste 213
Macomb, IL 61455-3378
Phone
(309) 837-6937
Fax
(309) 837-1979
NPI assigned
Jun 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Authorized official

Name
William Murdock
Title
Cfo
Phone
(563) 244-3511

Specialties & licenses 1

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

Addresses

Primary practice location

515 E Grant St Ste 213
Macomb, IL 61455-3378

Mailing address

PO Box 1179
Macomb, IL 61455-5579
Phone (309) 836-1524

Other practice location 1

515 E Grant St Ste 113
Macomb, IL 61455-3315
Phone (309) 833-6937

Other practice location 2

515 E Grant St Ste 211
Macomb, IL 61455-3378
Phone (309) 833-3706

Other practice location 3

515 E Grant St Ste 111
Macomb, IL 61455-3315
Phone (309) 837-6937

Other names 1

  • MDH Family Medicine/Convenience Care/Surgery/ENT Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200715002353 IL Part A Provider - Rural Health Clinic 0446140180 Practice locations: Macomb, IL

Rural health clinic certification: CCN 148619

Legal name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Doing business as
MDH FAMILY MEDICINE/CONVENIENCE CARE/SURGERY/ENT CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 18, 2020
Last certification
Nov 18, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
515 E Grant St
Stes 112, 113, 211 & 213
Macomb, IL 61455-3313
Related CCNs
140089

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

Other NPIs with the same Medicare PAC ID 10

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
14D2136040MDH Fam Med/Convenience Care/Surgery/ENT Clinic515 E Grant, Stes 112, 113, 211, 213, Macomb, IL 61455Certificate of waiverAug 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
McDonough Dist Hosp Nuc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

515 E Grant St
Ste 113
Macomb, IL 61455
Phone (309) 833-6937

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
McDonough County Hospital District Organization, Macomb, IL 5% Or Greater Direct Ownership Interest Jul 1, 2020 100%
Sherri L Hitchcock Individual Corporate OfficerCfo Feb 1, 2025
W-2 Managing EmployeeCfo Feb 1, 2025
William R Murdock Individual Corporate OfficerPresident & Ceo Apr 22, 2019
W-2 Managing EmployeePresident & Ceo Apr 22, 2019

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
McDonough District HospitalMacomb, IL, CCN 140089 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2018
McDonough District HospitalMacomb, IL, CCN 14U089 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2014
McDonough District Hospital Home HealthMacomb, IL, CCN 147293 Home health agency Operational/Managerial Control (100%) Oct 22, 2012
McDonough District HospitalMacomb, IL, CCN 141524 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 12, 1989
Bushnell Family PracticeBushnell, IL, CCN 148522 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2013
MDH Pediatric ClinicMacomb, IL, CCN 148617 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1235755372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1179",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614555579",
            "telephone_number": "309-836-1524",
            "fax_number": "309-836-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E GRANT ST STE 213",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553378",
            "telephone_number": "309-837-6937",
            "fax_number": "309-837-1979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 E Grant St Ste 113",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "IL",
            "postal_code": "614553315",
            "country_code": "US",
            "telephone_number": "309-833-6937",
            "fax_number": "309-836-6729",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 E Grant St Ste 211",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "IL",
            "postal_code": "614553378",
            "country_code": "US",
            "telephone_number": "309-833-3706",
            "fax_number": "309-836-1039",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 E Grant St Ste 111",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "IL",
            "postal_code": "614553315",
            "country_code": "US",
            "telephone_number": "309-837-6937",
            "fax_number": "309-837-1979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MCDONOUGH COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "MURDOCK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "563-244-3511"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDH Family Medicine/Convenience Care/Surgery/ENT Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macomb, IL

Sources for this page

Verify at the official NPI Registry.