NPIMap

Organization Active NPI

Mendota Community Hospital

Doing business as OSF Saint Paul Medical Center

  • Rural Health Clinic/Center
  • Mendota, IL
National Provider Identifier
1316320849
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MENDOTA COMMUNITY HOSPITAL
Doing business as
OSF Saint Paul Medical Center
Practice address
1405 E 12TH St
Mendota, IL 61342-9010
Phone
(815) 539-7461
NPI assigned
Jul 1, 2015
Last updated
Jan 8, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
OSF HEALTHCARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Authorized official

Name
Robert C. Sehring
Title
Ceo, Osf Healthcare System
Phone
(309) 655-2850

Specialties & licenses 1

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

Addresses

Primary practice location

1405 E 12TH St
Mendota, IL 61342-9010

Mailing address

124 SW Adams St
Peoria, IL 61602-1320
Phone (309) 655-2850

Other names 1

  • OSF Saint Paul Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140619002050 IL Part A Provider - Rural Health Clinic 2264335777 1 other NPI on this enrollment
Practice locations: Mendota, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316320849. Details of each certification follow.

Rural health clinic certification: CCN 148535

Legal name
MENDOTA COMMUNITY HOSPITAL
Doing business as
OSF HEALTHCARE - MEDICAL GROUP - MENDOTA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 11, 2015
Last certification
Feb 11, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1965 in IL
Enrollment address
1405 E 12TH St, Ste 300, 600
Mendota, IL 61342-9010
Related CCNs
141310

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

Other NPIs with the same Medicare PAC ID 8

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
ER Physciains GRP11 organizations share this tax ID, including this one
Part of
Osf Healthcare System

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Patricia a Brazeau Individual Corporate Officer Oct 1, 2006
Corporate Director Oct 1, 2006
Dawn C Trompeter Individual Contracted Managing EmployeePresident Jan 1, 2019
Operational/Managerial ControlPresident Jan 1, 2019
Anne M Ziegler Individual Corporate Director Jul 1, 2021
Melanie R Mann Individual Corporate Officer Oct 6, 2024
Corporate Director Oct 1, 2006
Gerald J McShane Individual Corporate Director Sep 1, 1996
Osf Healthcare Ministries Organization, Peoria, IL Non-profit Operational/Managerial Control Nov 1, 2024
Michelle a Carrothers Individual Operational/Managerial ControlVP, Strategic Reimbursement Feb 1, 2018
Kathleen F Williams Individual Corporate Officer Nov 1, 2014
Corporate Director Jan 1, 2003
Kirsten M Largent Individual Contracted Managing EmployeeCfo, Osf Healthcare System Nov 8, 2024
Corporate Officer Nov 8, 2024
Operational/Managerial Control Nov 8, 2024
Osf Healthcare System Organization, Peoria, IL Corporation, Non-profit Operational/Managerial Control Apr 1, 2015
Robert C Sehring Individual Contracted Managing EmployeeCeo, Osf Healthcare System Oct 20, 2017
Corporate Officer Oct 20, 2017
Corporate Director Oct 20, 2017
Operational/Managerial Control Oct 20, 2017
Judith a Duvall Individual Corporate Officer Oct 1, 2006
Corporate Director Oct 1, 1989
Carisa a Neumann Individual Corporate Director Jul 1, 2021
Brian J Silverstein Individual Corporate Director Jan 27, 2014
Paula K Selamat Individual Corporate Director Oct 6, 2024
Bridget J Meidl Individual Corporate Director Nov 1, 2014

Owners & managing parties with NPI records 1

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

Facilities with the same owner 76

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

View all 76

NPI Registry JSON

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1316320849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SW ADAMS ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021320",
            "telephone_number": "309-655-2850",
            "fax_number": "815-539-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 E 12TH ST",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613429010",
            "telephone_number": "815-539-7461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOTA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OSF HEALTHCARE SYSTEM",
        "enumeration_date": "2015-07-01",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "SEHRING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO, OSF HEALTHCARE SYSTEM",
        "authorized_official_telephone_number": "309-655-2850"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSF Saint Paul Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OSF Saint Paul Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mendota, IL

Sources for this page

Verify at the official NPI Registry.