NPIMap

Organization Active NPI

Fairfield Memorial Hospital Association

  • Rural Health Clinic/Center
  • Fairfield, IL
National Provider Identifier
1295908853
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Practice address
213 NW 10TH St
Suite a
Fairfield, IL 62837-1219
Phone
(618) 842-4617
Fax
(618) 842-4743
NPI assigned
Apr 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Authorized official

Name
Mary Knight
Title
Staff Accountant
Phone
(618) 847-8346

Specialties & licenses 1

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

Addresses

Primary practice location

213 NW 10TH St
Suite a
Fairfield, IL 62837-1219

Mailing address

303 NW 11TH St
Fairfield, IL 62837-1203
Phone (618) 842-2611

Other names 1

  • Horizon Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20081111000210 IL Part A Provider - Rural Health Clinic 5698671741 Practice locations: Fairfield, IL
O20180220001951 IL Part A Provider - Rural Health Clinic 5698671741 Practice locations: Cisne, IL
O20200113000138 IL Part A Provider - Rural Health Clinic 5698671741 Practice locations: Carmi, IL
O20221213002235 IL Part A Provider - Rural Health Clinic 5698671741 Practice locations: Fairfield, IL

Rural health clinic certification: CCN 148500

Legal name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Doing business as
HORIZON HEALTHCARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 13, 2009
Last certification
Dec 22, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
213 NW 10TH St
Ste a
Fairfield, IL 62837-1219
Related CCNs
141311

Rural health clinic certification: CCN 148591

Legal name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Doing business as
HORIZON HEALTHCARE CISNE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 12, 2018
Last certification
Jul 12, 2018
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
413 Park St
Cisne, IL 62823-9450
Related CCNs
141311

Rural health clinic certification: CCN 148614

Legal name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Doing business as
HORIZON HEALTHCARE CARMI MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 12, 2020
Last certification
Aug 12, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
1103 W Main St
Carmi, IL 62821-1380
Related CCNs
141311

Rural health clinic certification: CCN 148656

Legal name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Doing business as
FAIRFIELD MEMORIAL HOSPITAL URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 25, 2023
Last certification
May 25, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
303 NW 11TH St
Fairfield, IL 62837-1203
Related CCNs
141311

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

Other NPIs with the same Medicare PAC ID 3

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

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
14D1091373Horizon Healthcare213 N W 10TH St Ste a, Fairfield, IL 62837Certificate of waiverOct 29, 2026
14D2265609Fairfield Memorial Urgent Care303 NW 11TH St, Fairfield, IL 62837Certificate of waiverJul 28, 2028

National Provider Directory

National Provider Directory

Locations

213 NW 10th St
Ste A
Fairfield, IL 62837
Phone (618) 842-4617

1021 Harding St
Fairfield, IL 62837
Phone (618) 842-4617

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11356/brand/1/csg/161/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
David Andrew Flemer Individual Contracted Managing EmployeeAd; Sep 8, 2025 100%
Operational/Managerial ControlChief Executive Officer Sep 8, 2025 100%
Corporate OfficerChief Executive Officer Sep 8, 2025 100%
Brianna Trowbridge Individual Corporate DirectorBoard Member Nov 18, 2025
Marc J Florence Individual Corporate DirectorFMH Board Member Apr 1, 2024 9.1%
Corporate DirectorFMH Board Member Apr 1, 2024
Michael Copeland Individual Corporate OfficerSecretary-Treasurer Jan 10, 2022
Corporate DirectorFMH Board Member Jan 9, 2023 9.1%
Corporate DirectorFMH Board Member Jan 9, 2023
Dana Shantel Taylor Individual Corporate OfficerChief Operating Officer Oct 24, 2023 100%
W-2 Managing EmployeeChief Operating Officer Oct 24, 2023
W-2 Managing EmployeeChief Operating Officer Oct 24, 2023 100%
Mary Knight Individual W-2 Managing EmployeeStaff Accountant Jul 6, 1998
OtherStaff Accountant Jul 6, 1998
Operational/Managerial ControlStaff Accountant Jul 6, 1998
W-2 Managing EmployeeExec Assistant/Staff Accountant Jul 6, 1998
Deaconess Health System Inc Organization, Evansville, IN Management services company, Chain home office Operational/Managerial Control Apr 1, 2024 100%
Randall Russell Individual Contracted Managing EmployeeChief Financial Officer Jun 1, 2026 100%
Patrick L Molt Individual Corporate OfficerPresident Jan 12, 2015
Corporate DirectorFMH Board Member Oct 28, 2008 9.1%
Corporate DirectorFMH Board Member Oct 28, 2008
Donna Masterson Individual Corporate DirectorFMH Board Member Jan 9, 2017 9.1%
Corporate DirectorFMH Board Member Jan 9, 2017
James Pollard Individual Corporate DirectorFMH Board Member Aug 1, 2008 9.1%
Corporate DirectorFMH Board Member May 1, 2008
Corporate DirectorFMH Board Member May 1, 2008 9.1%
Matthew Seng Individual Corporate DirectorFMH Board Member Jan 10, 2022 9.1%
Corporate DirectorFMH Board Member Jan 10, 2022
Shawn W McCoy Individual Operational/Managerial Control Apr 1, 2024 100%
Doug Wilson Individual Corporate DirectorFMH Board Member Jan 11, 2016 9.1%
Corporate DirectorFMH Board Member Jan 11, 2016
Josh Scott Individual Corporate DirectorFMH Board Member Jan 9, 2023 9.1%
Corporate DirectorFMH Board Member Jan 9, 2023
Jared Stimpson Individual Corporate DirectorBoard Member Mar 24, 2026 9.1%
Anita K Pond Individual Corporate DirectorFMH Board Member Jan 12, 2015 9.1%
Corporate DirectorFMH Board Member Jan 12, 2015
Fairfield Memorial Hospital Association Organization, Fairfield, IL Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Operational/Managerial Control Jan 1, 2018 100%
5% Or Greater Direct Ownership Interest Jan 2, 2020 100%
5% Or Greater Direct Ownership Interest Jun 20, 2022 100%
Hollie Barrett Individual W-2 Managing EmployeePractice Director May 11, 2010 100%
Operational/Managerial ControlClinic Practice Manager May 10, 2010 100%
Corporate DirectorDirector of Physician Practices Oct 19, 2024 100%
W-2 Managing EmployeeDirector of Physician Practices Dec 20, 2024 100%
Corporate DirectorDirector of Physician Practice Aug 1, 2016 100%
Operational/Managerial ControlDirector of Physician Practice Jan 2, 2020 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Fairfield Memorial HospitalFairfield, IL, CCN 141311 Hospital Operational/Managerial Control (100%) Apr 1, 2021
Fairfield Memorial HospitalFairfield, IL, CCN 14Z311 Hospital Operational/Managerial Control (100%) Apr 1, 2024
Fairfield Memorial HospitalFairfield, IL, CCN 145552 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF
Direct Ownership Interest (100%)		 Jan 1, 1966
Jan 1, 1966
Jan 1, 1966
Jan 1, 1966

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771977600000",
    "number": "1295908853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 NW 11TH ST",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "628371203",
            "telephone_number": "618-842-2611",
            "fax_number": "618-847-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 NW 10TH ST",
            "address_2": "SUITE A",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "628371219",
            "telephone_number": "618-842-4617",
            "fax_number": "618-842-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-03",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "STAFF ACCOUNTANT",
        "authorized_official_telephone_number": "618-847-8346"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horizon Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, IL

Sources for this page

Verify at the official NPI Registry.