NPIMap

Organization Active NPI

Midwest Medical Center

  • Rural Health Clinic/Center
  • Elizabeth, IL
National Provider Identifier
1295286045
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
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
Oct 17, 2016
Last updated
Oct 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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

Authorized official

Name
Tracy L Bauer
Title
President/Ceo
Phone
(815) 777-1340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 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
O20160411002078 IL Part A Provider - Rural Health Clinic 5698771848 1 other NPI on this enrollment
Practice locations: Elizabeth, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295286045. Details of each certification follow.

Rural health clinic certification: CCN 148557

Legal name
MIDWEST MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 15, 2016
Last certification
Jul 15, 2016
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jul 1, 2008 in IL
Enrollment address
117 N Main St
Elizabeth, IL 61028-8800
Related CCNs
141302

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

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.

Locations

1 Medical Center Dr
Galena, IL 61036
Phone (815) 776-7381

412 S Main St
Ste 202
Galena, IL 61036
Phone (815) 281-1345

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Katherine a Meusel Individual W-2 Managing Employee Oct 12, 2015
Robert L. Miller Individual Corporate Director Jan 1, 2009
Mary Sheahen Individual Corporate Director Apr 16, 2007
Cheryl a. Farruggia Individual Corporate Director Jan 1, 2008
William J. Morden Individual Corporate Director Jan 1, 2006
Tracy L Bauer Individual Corporate Officer Apr 16, 2007
Operational/Managerial Control Apr 16, 2007
Midwest Medical Foundation Organization, Galena, IL Non-profit 5% Or Greater Indirect Ownership Interest Apr 25, 2019 100%

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 69

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.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1295286045",
    "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": "815-777-2560"
        },
        {
            "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": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "815-777-1340"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, IL

Sources for this page

Verify at the official NPI Registry.