NPIMap

Organization Active NPI

Memorial Physician Services

  • Rural Health Clinic/Center
  • Beardstown, IL
National Provider Identifier
1245822170
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEMORIAL PHYSICIAN SERVICES
Practice address
8460 Saint Lukes Dr
Beardstown, IL 62618-8385
Phone
(217) 544-0306
Fax
(217) 323-1739
NPI assigned
Feb 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
Ann Bowling
Title
Director
Phone
(217) 588-2626

Specialties & licenses 1

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

Addresses

Primary practice location

8460 Saint Lukes Dr
Beardstown, IL 62618-8385

Mailing address

8460 Saint Lukes Dr
Beardstown, IL 62618-8385
Phone (217) 544-0306

Other identifiers 1

IdentifierTypeStateIssuer
148905OtherILRHC PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210311002373 IL Part A Provider - Rural Health Clinic 9032005681 Practice locations: Beardstown, IL

Rural health clinic certification: CCN 783854

Legal name
MEMORIAL PHYSICIAN SERVICES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 4, 2022
Last certification
Mar 4, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 8, 2021 in IL
Enrollment address
8460 Saint Lukes Dr
Beardstown, IL 62618-8385

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Memorial Physician Services12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

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
Christina L Scheibler-Ventress Individual Corporate OfficerMD Jan 12, 2023
Corporate DirectorMD Jan 12, 2023
David B Sandercock Individual Corporate OfficerMD Jan 10, 2024
Corporate DirectorMD Jan 10, 2024
Mandy C. Eaton Individual Corporate DirectorPresident & Ceo MH Apr 1, 2025
Nathan Pyle Individual Corporate OfficerDO Jan 12, 2023
Corporate DirectorDO Jan 12, 2023
Jameson Roszhart Individual Corporate OfficerPresident & Ceo Jul 1, 2024
Corporate DirectorPresident & Ceo Jul 1, 2024
W-2 Managing Employee Jun 15, 2009
Kimberly R Beggs Individual Corporate OfficerPresident & Ceo MPS Jul 1, 2024
W-2 Managing Employee Dec 18, 2000
Memorial Health System Organization, Springfield, IL Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1997
Drew Early Individual Corporate OfficerPresident & Ceo DMH Jan 10, 2024
Corporate DirectorPresident & Ceo DMH Jan 10, 2024
Anthony M Griffin Individual Corporate OfficerMD Jan 10, 2018
Corporate DirectorMD Jan 10, 2018
Judi Harlan Individual W-2 Managing Employee Mar 1, 2020
Kathryn J Keim Individual Corporate OfficerSenior VP & Ceo Jan 1, 2019
Corporate Director Jan 1, 2019
W-2 Managing Employee Jun 6, 2005
Stephanie Seaman Individual W-2 Managing Employee Feb 1, 2014
Amir J Wahab Individual Corporate OfficerMD Sep 8, 2021
Corporate DirectorMD Sep 8, 2021
Ann E Bowling Individual W-2 Managing EmployeeDirector Apr 5, 2010

Owners & managing parties with NPI records 5

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 161

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

View all 161

NPI Registry JSON

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1245822170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8460 SAINT LUKES DR",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626188385",
            "telephone_number": "217-544-0306",
            "fax_number": "217-323-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8460 SAINT LUKES DR",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626188385",
            "telephone_number": "217-544-0306",
            "fax_number": "217-323-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "BOWLING",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-588-2626"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHC PTAN",
            "identifier": "148905",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beardstown, IL

Sources for this page

Verify at the official NPI Registry.