NPIMap

Organization Active NPI

HSHS Prairie, Inc

Doing business as HSHS Medical Group Family & Internal Medicine - Effingham

  • Rural Health Clinic/Center
  • Effingham, IL
National Provider Identifier
1265904486
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HSHS PRAIRIE, INC
Doing business as
HSHS Medical Group Family & Internal Medicine - Effingham
HSHS Prairie Primary Care - Effingham
Practice address
900 W Temple Ave Ste 1500
Effingham, IL 62401-2121
Phone
(217) 347-0458
Fax
(217) 342-2992
NPI assigned
Dec 28, 2018
Last updated
Oct 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
HSHS PRAIRIE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Authorized official

Name
Heath M. Roberts
Title
President
Phone
(217) 492-9648

Specialties & licenses 1

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

Addresses

Primary practice location

900 W Temple Ave Ste 1500
Effingham, IL 62401-2121

Mailing address

3051 Hollis Dr
Springfield, IL 62704-7450
Phone (217) 492-9695

Other names 2

  • HSHS Medical Group Family & Internal Medicine - Effingham Doing business as
  • HSHS Prairie Primary Care - Effingham Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190530002877 IL Part A Provider - Rural Health Clinic 5092857821 Practice locations: Effingham, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265904486. Details of each certification follow.

Rural health clinic certification: CCN 148959

Legal name
HSHS MEDICAL GROUP INC
Doing business as
HSHS MEDICAL GROUP FAMILY & INTERNAL MEDICINE - EFFINGHAM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 9, 2004
Last certification
Dec 27, 2022
Ownership / control type
2B
Most recent change of ownership
Oct 30, 2018 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
900 W Temple Ave
Building B Suite 1500
Effingham, IL 62401-2187

Other NPIs with the same Medicare PAC ID 8

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

  • HSHS Prairie, Inc

    dba HSHS Medical Group Family Medicine - Dieterich

    • Rural Health Clinic/Center
    • Dieterich, IL
    • NPI 1033841192

    5092857821

    Same PAC ID
  • HSHS Prairie, Inc

    dba HSHS Prairie Foot and Ankle - Springfield

    • Durable Medical Equipment & Medical Supplies
    • Springfield, IL
    • NPI 1467849257

    5092857821

    Same PAC ID
  • HSHS Prairie, Inc

    dba HSHS Prairie Foot and Ankle - Jacksonville

    • Durable Medical Equipment & Medical Supplies
    • Jacksonville, IL
    • NPI 1629465414

    5092857821

    Same PAC ID
  • HSHS Prairie, Inc

    dba HSHS Medical Group Family Medicine - Altamont

    • Rural Health Clinic/Center
    • Altamont, IL
    • NPI 1679108351

    5092857821

    Same PAC ID
  • HSHS Medical Group Inc

    dba Quick Care - Powered by HSHS Medical Group

    • Rural Health Clinic/Center
    • Newton, IL
    • NPI 1679236533

    5092857821

    Same PAC ID
  • HSHS Prairie, Inc

    dba HSHS Prairie Foot and Ankle - Breese

    • Durable Medical Equipment & Medical Supplies
    • Breese, IL
    • NPI 1740677533

    5092857821

    Same PAC ID
  • HSHS Prairie, Inc

    dba HSHS Medical Group Inc

    • Rural Health Clinic/Center
    • Highland, IL
    • NPI 1851536296

    5092857821

    Same PAC ID
  • HSHS Prairie, Inc
    • Multi-Specialty Clinic/Center
    • Springfield, IL
    • NPI 1962644807

    5092857821

    Same PAC ID

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
14D2114334HSHS Med Group - Effingham Specialty Care900 W Temple - Ste 2500, Effingham, IL 62401Certificate of waiverJun 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
HSHS Medical Group18 organizations share this tax ID, including this one
Part of
HSHS Medical Group

Other organizations with this tax ID 17

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

View all 17

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
John Slayton Individual Corporate DirectorDirector Oct 30, 2018
Kevin Lewis Individual Corporate OfficerSVP Chief Physician Executive Aug 28, 2023
W-2 Managing Employee Aug 28, 2023
James F Burgett Individual Corporate DirectorBoard Member Oct 30, 2018
Heather Spath Individual Corporate OfficerManager of Medical Staff Nov 21, 2017
Hospital Sisters Services Inc Organization, Springfield, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 30, 2018
Timothy Nicoud Individual Corporate OfficerBoard Member Oct 30, 2018
Damond Williams Boatwright Individual Corporate Officer Jun 1, 2021
Dona S McGraw Individual Corporate OfficerBoard Member Oct 30, 2018

Facilities with the same owner 24

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

View all 24

Change-of-ownership history 1

DateEventCounterparty
Oct 30, 2018 Change of OwnershipThis provider was the buyer Dr. Eugene DustCCN 148959, IL, NPI 1568651925

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792022400000",
    "number": "1265904486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 HOLLIS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047450",
            "telephone_number": "217-492-9695",
            "fax_number": "217-492-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W TEMPLE AVE STE 1500",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012121",
            "telephone_number": "217-347-0458",
            "fax_number": "217-342-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HSHS PRAIRIE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HSHS PRAIRIE, INC",
        "enumeration_date": "2018-12-28",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "HEATH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-492-9648"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HSHS Medical Group Family & Internal Medicine - Effingham",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HSHS Prairie Primary Care - Effingham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.