NPIMap

Organization Active NPI

Christopher Greater Area Rural Health Planning Corporation

  • Federally Qualified Health Center (FQHC)
  • Shawneetown, IL
National Provider Identifier
1285614867
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Practice address
9525 Gold Hill Road
Shawneetown Health Care Clinic
Shawneetown, IL 62984
Phone
(618) 269-3815
Fax
(618) 269-3274
NPI assigned
Jan 19, 2006
Last updated
Jan 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Authorized official

Name
Kimberly Mitroka
Title
Ceo
Phone
(618) 724-2401

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

9525 Gold Hill Road
Shawneetown Health Care Clinic
Shawneetown, IL 62984

Mailing address

PO Box 155
Christopher Greater Area Rural Health Planning Corp
Christopher, IL 62822
Phone (618) 724-2401

Other names 1

  • Shawneetown Healthcare Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030606000006 IL Part A Provider - Federally Qualified Health Center (FQHC) 8224947387 Practice locations: Shawneetown, IL
O20040109000561 IL Part B Supplier - Clinic/Group Practice 8224947387 Receives reassigned benefits from 71 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shawneetown, IL; Sesser, IL; Mount Vernon, IL; Johnston City, IL; Flora, IL; Fairfield, IL; Eldorado, IL; Du Quoin, IL…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285614867. Details of each certification follow.

Federally qualified health center certification: CCN 141940

Legal name
CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Doing business as
SHAWNEETOWN HEALTHCARE CLINC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2003
Last certification
Jun 19, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 1977 in IL
Enrollment address
9525 Gold Hill Rd
Shawneetown, IL 62984-3659
Related CCNs
140010

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Christopher Rural Health Planning Corp20 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

103 Commerce St
Carmi, IL 62821
Phone (618) 384-5686

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John Hosselton Individual Corporate Director Jun 6, 2003
Gary Kelly Individual Corporate Director Jan 1, 2014
Ruth Stanford Individual Corporate Director Jun 6, 2003
Paul J Cruz Individual Corporate Director Mar 31, 2014
Marian Smith-Furlow Individual Corporate Director Jan 1, 2014
Kimberly a. Mitroka Individual Corporate Director Jun 6, 2003
W-2 Managing EmployeeCeo Jun 6, 2003
Thomas Konopasek Individual Corporate Director Mar 23, 2015
Richard Schablowsky Individual Corporate Director Mar 24, 2004
Dorothy Deangelo Individual Corporate Director Jun 6, 2003
Lisa Hopkins Individual Corporate Director Apr 1, 2008
Gerald Hearring Individual Corporate Director Mar 23, 2003

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mt. Vernon Community Health CenterMt Vernon, IL, CCN 141022 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2005
Johnston City Community Health CenterJohnston City, IL, CCN 141065 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2009
Crhpc Comprehensive Behavioral Health ServicesDu Quoin, IL, CCN 781074 Federally qualified health center Operational/Managerial Control (100%) Jul 8, 1977

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 7

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": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769731200000",
    "number": "1285614867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "address_2": "CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP",
            "city": "CHRISTOPHER",
            "state": "IL",
            "postal_code": "62822",
            "telephone_number": "618-724-2401",
            "fax_number": "618-724-2571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 GOLD HILL ROAD",
            "address_2": "SHAWNEETOWN HEALTH CARE CLINIC",
            "city": "SHAWNEETOWN",
            "state": "IL",
            "postal_code": "62984",
            "telephone_number": "618-269-3815",
            "fax_number": "618-269-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A",
        "authorized_official_last_name": "MITROKA",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-724-2401"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawneetown Healthcare Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Shawneetown Healthcare Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shawneetown, IL

Sources for this page

Verify at the official NPI Registry.