NPIMap

Organization Active NPI

Protestant Memorial Medical Center, Inc.

  • Skilled Nursing Facility
  • Belleville, IL
National Provider Identifier
1285729210
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0003103 Issued in IL
Legal business name
PROTESTANT MEMORIAL MEDICAL CENTER, INC.
Practice address
4315 Memorial Dr
Belleville, IL 62226-5342
Phone
(618) 257-5060
Fax
(618) 257-6940
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Authorized official

Name
Ms. Jane Gusmano
Title
Vice President
Phone
(618) 257-5606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0003103 IL Primary

Addresses

Primary practice location

4315 Memorial Dr
Belleville, IL 62226-5342

Mailing address

4315 Memorial Dr
Belleville, IL 62226-5342
Phone (618) 257-5060

Other identifiers 1

IdentifierTypeStateIssuer
390635502002MedicaidIL

Other names 1

  • Memorial Care Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100426000079 IL Part A Provider - Skilled Nursing Facility 2961461314 Practice locations: Belleville, IL

Skilled nursing facility certification: CCN 145102

Legal name
PROTESTANT MEMORIAL MEDICAL CENTER, INC.
Doing business as
MEMORIAL CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 1, 1967
Last certification
Dec 6, 2024
Beds
82
Ownership / control type
Nonprofit Corporation
Multi-facility organization
BJC
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1947 in IL
Enrollment address
4315 Memorial Dr
Belleville, IL 62226-5342
Nursing home name
MEMORIAL CARE CENTER
Affiliated entity
BJC HEALTHCARE

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Memorial Care CenterCCN 145102
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8268.3 residents per day on average
Chain
BJC Healthcare4 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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
14D2255033Memorial Care Center4315 Memorial Dr, Belleville, IL 62226Certificate of waiverMar 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosp Eeg5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member organizations 1

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

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Kurtis S Schroeder Individual Corporate DirectorBoard Member Jan 1, 2021
Jeffrey D Parks Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Dec 30, 2025
Rebecca Olroyd Individual Corporate DirectorBoard Member Jan 1, 2025
Rachel Jackson Individual Corporate DirectorBoard Member Jan 1, 2019
Michele McKee Individual Corporate OfficerVice President Mar 25, 2026
Operational/Managerial Control Mar 25, 2026
Hans H Moosa Individual Corporate DirectorBoard Member Jan 1, 2021
Valerie L Thaxton Individual Corporate Officer1St Vice Chair Jan 1, 2021
Corporate DirectorBoard Member Jan 1, 2021
Randolph Ganim Individual Corporate DirectorBoard Member Jan 1, 2023
Ronald Stephens Individual Corporate DirectorBoard Member Jan 1, 2021
Organization, San Diego, CA Medical staffing company, For-profit Adp of the SNF Dec 23, 2025
Protestant Memorial Medical Center, Inc. Organization, Belleville, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 17, 2010 100%
Operational/Managerial Control Feb 17, 2010
Organization, Glenview, IL Medical provider/supplier, For-profit Adp of the SNF Dec 23, 2025
Beatriz C Pardo Individual Corporate DirectorBoard Member Jan 1, 2017
Kevin a Journagan Individual Corporate DirectorVice President Sep 16, 2024
Operational/Managerial Control Sep 16, 2024
Roger Byrne Individual Corporate OfficerVice President Apr 1, 2022
Corporate DirectorVice President Apr 1, 2022
Operational/Managerial Control Mar 25, 2026
Edward Hoering Individual Corporate DirectorBoard Member Feb 7, 2010
Chris a Eckert Individual Corporate OfficerBoard Member Jan 1, 2021
Corporate DirectorBoard Member Jan 1, 2021
Bethesda Health Group Inc Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Feb 17, 2010 100%
Operational/Managerial Control Feb 17, 2010
Jeffrey Dossett Individual Corporate OfficerVice President Jun 23, 2020
Corporate DirectorVice President Jun 23, 2020
Operational/Managerial Control Jun 23, 2020
Keri Bryer Individual Operational/Managerial Control Oct 11, 2022
Adp of the SNF Dec 30, 2025
Organization, Overland Park, KS Medical staffing company, For-profit Adp of the SNF Dec 23, 2025
Individual Adp of the SNF Jan 1, 2025
Staci Oliver Individual Corporate DirectorBoard Member Jan 1, 2021
Geri Boyer Individual Corporate DirectorBoard Member Jan 1, 2017
Teresa Halloran Individual Corporate OfficerVice President Nov 14, 2016
Corporate DirectorVice President Nov 14, 2016
Operational/Managerial Control Nov 14, 2016
Rob Dyer Individual Corporate Officer2ND Vice Chair Jan 1, 2016
Corporate DirectorBoard Member Jul 30, 2013
Keith Cook Individual Corporate DirectorBoard Member Jan 1, 2021

Owners & managing parties with NPI records 6

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1285729210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4315 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265342",
            "telephone_number": "618-257-5060",
            "fax_number": "618-257-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265342",
            "telephone_number": "618-257-5060",
            "fax_number": "618-257-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTESTANT MEMORIAL MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "GUSMANO",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "618-257-5606",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0003103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390635502002",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4315 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Memorial Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.