NPIMap

Organization Active NPI

Midwest Medical Center

  • Clinic/Center
  • Elizabeth, IL
National Provider Identifier
1295126944
Registry record updated Feb 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MIDWEST MEDICAL CENTER
Practice address
117 N Main St
Elizabeth, IL 61028-8800
Phone
(815) 858-2238
Fax
(815) 858-2239
NPI assigned
Feb 16, 2015
Last updated
Feb 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2015

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

Authorized official

Name
Tracy L Bauer, CEO
Title
Ceo
Phone
(815) 777-1340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X IL Primary

Addresses

Primary practice location

117 N Main St
Elizabeth, IL 61028-8800

Mailing address

1 Medical Center Dr
Galena, IL 61036-8118
Phone (815) 777-1340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061011000044 IL Part A Provider - Critical Access Hospital 5698771848 Receives reassigned benefits from 49 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elizabeth, IL; Galena, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295126944. Details of each certification follow.

Hospital certification: CCN 141302

Legal name
MIDWEST MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2000
Last certification
Sep 28, 2023
Beds
19
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jul 1, 2006 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 2008 in IL
Enrollment address
1 Medical Center Dr
Galena, IL 61036-8118

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Midwest Medical CenterCCN 141302 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Midwest Medical Center5 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.

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
Paul Carter Newton Individual Corporate Director Jan 1, 2019
Katherine a Meusel Individual W-2 Managing EmployeeClinic Manager Dec 14, 2015
Matthew Carroll Individual Corporate Director Jan 1, 2019
Joel C Holland Individual Corporate DirectorBoard Member May 2, 2017
Donna Ferry Individual Corporate Director Jan 1, 2019
John M Lorenzen Individual Corporate DirectorBoard Member May 2, 2017
Lynn Zehnder Individual Corporate Director Jan 1, 2021
Barbara K Sloan Individual Corporate DirectorBoard Member May 2, 2017
Helen R Kilgore Individual Corporate DirectorBoard Member Jan 1, 2007
Tim Vincent Individual Corporate Director Jan 1, 2022
Chris Curran Individual Corporate Director Jan 1, 2022
Kelli Jackson Individual Corporate OfficerController Aug 7, 2019
Tracy L Bauer Individual Corporate OfficerCeo Apr 10, 2015
Midwest Medical Foundation Organization, Galena, IL Non-profit 5% Or Greater Indirect Ownership Interest Apr 25, 2019 100%

Practitioners & affiliated clinicians

Affiliated clinicians 90

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

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1424044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424044800000",
    "number": "1295126944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "GALENA",
            "state": "IL",
            "postal_code": "610368118",
            "telephone_number": "815-777-1340",
            "fax_number": "815-776-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N MAIN ST",
            "city": "ELIZABETH",
            "state": "IL",
            "postal_code": "610288800",
            "telephone_number": "815-858-2238",
            "fax_number": "815-858-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-16",
        "last_updated": "2015-02-16",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-777-1340",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, IL

Sources for this page

Verify at the official NPI Registry.