NPIMap

Organization Active NPI

Mason Hospital District

Doing business as MASON DISTRICT HOSp HOME HEALTH

  • Home Health Agency
  • Havana, IL
National Provider Identifier
1265548010
Registry record updated Mar 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
001002088 Issued in IL
Legal business name
MASON HOSPITAL DISTRICT
Doing business as
MASON DISTRICT HOSp HOME HEALTH
Practice address
741 E Laurel Ave
Havana, IL 62644-1551
Phone
(309) 543-6137
Fax
(309) 543-4442
NPI assigned
Aug 22, 2006
Last updated
Mar 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2012

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

Authorized official

Name
Mr. Harry Wolin
Title
Ceo
Phone
(309) 543-4431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 001002088 IL Primary

Addresses

Primary practice location

741 E Laurel Ave
Havana, IL 62644-1551

Mailing address

615 N. Promenade
Havana, IL 62644-0530
Phone (309) 543-6137

Other names 1

  • MASON DISTRICT HOSp HOME HEALTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100223000362 IL Part A Provider - Home Health Agency 2466360607 Practice locations: Havana, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265548010. Details of each certification follow.

Home health agency certification: CCN 147202

Legal name
MASON HOSPITAL DISTRICT
Doing business as
MASON DISTRICT HOSPITAL HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 9, 1982
Last certification
Feb 27, 2020
Ownership / control type
Government Operated
Organization structure
GovernmentNon-profit
Incorporated
Jul 25, 2013 in IL
Enrollment address
741 E Laurel Ave
Havana, IL 62644-1551

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Mason District Hospital Home HealthCCN 147202 · All quality measures
Overall star rating
3 of 5
Ownership
Government Operated
Certified
Jan 9, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Asadullah Saira MD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

741 E Laurel Ave
Havana, IL 62644
Phone (309) 543-6137

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Randall R Fornoff Individual Corporate Director Dec 29, 2009
Mason Hospital District Organization, Havana, IL 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Operational/Managerial Control Dec 29, 2009
Terri Brownfield Individual Corporate Director Dec 29, 2009
Leann K Bonnett Individual Corporate OfficerCfo Sep 3, 2015
W-2 Managing Employee Sep 3, 2015
Operational/Managerial Control Sep 3, 2015
Douglas Kosier Individual Corporate OfficerCeo Jun 27, 2000
W-2 Managing Employee Jun 27, 2000
Operational/Managerial Control Jun 27, 2000
Alan Tucker Individual Corporate Director Dec 29, 2009
Daniel Houghton Individual Corporate Director Dec 29, 2009
William R Blessman Individual Corporate Director Dec 29, 2009

Owners & managing parties with NPI records 4

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

  • Mason Hospital District

    dba Havana Medical Associates

    • Rural Health Clinic/Center
    • Havana, IL
    • NPI 1063478782

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mason Hospital District

    dba Manito Medical Associates

    • Rural Health Clinic/Center
    • Manito, IL
    • NPI 1780128512

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mason Hospital District

    dba Mason District Hospital

    • Critical Access Hospital
    • Havana, IL
    • NPI 1902849649

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mason Hospital District

    dba Mason City Medical Associates

    • Rural Health Clinic/Center
    • Mason City, IL
    • NPI 1932166931

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Mason District HospitalHavana, IL, CCN 141313 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 23, 2014
Mason District HospitalHavana, IL, CCN 14Z313 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2011
Havana Medical AssociatesHavana, IL, CCN 143457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2001
Manito Medical AssociatesManito, IL, CCN 148592 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 9

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

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331510400000",
    "number": "1265548010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N. PROMENADE",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626440530",
            "telephone_number": "309-543-6137",
            "fax_number": "309-543-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 E LAUREL AVE",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626441551",
            "telephone_number": "309-543-6137",
            "fax_number": "309-543-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASON HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2012-03-12",
        "status": "A",
        "authorized_official_last_name": "WOLIN",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-543-4431",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "001002088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MASON DISTRICT HOSp HOME HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Havana, IL

Sources for this page

Verify at the official NPI Registry.