NPIMap

Organization Active NPI

Deaconess Illinois Crossroads Inc

Doing business as Crossroads Internal Medicine

  • Rural Health Clinic/Center
  • Mount Vernon, IL
National Provider Identifier
1316663602
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DEACONESS ILLINOIS CROSSROADS INC
Doing business as
Crossroads Internal Medicine
Deaconess Illinois Crossroads Family Clinic Mt. Vernon
Deaconess Illinois Rural Health Clinic Mt. Vernon
Practice address
4101 N Water Tower PL
Mount Vernon, IL 62864-6296
Phone
(618) 244-4313
Fax
(618) 246-1247
NPI assigned
Oct 18, 2022
Last updated
Feb 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Authorized official

Name
Jason Hinkle
Title
Cfo
Phone
(865) 599-4770

Specialties & licenses 1

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

Addresses

Primary practice location

4101 N Water Tower PL
Mount Vernon, IL 62864-6296

Mailing address

PO Box 631956
Cincinnati, OH 45263-1956
Phone (812) 450-6815

Other names 3

  • Crossroads Internal Medicine Doing business as
  • Deaconess Illinois Crossroads Family Clinic Mt. Vernon Doing business as
  • Deaconess Illinois Rural Health Clinic Mt. Vernon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230221000097 IL Part B Supplier - Clinic/Group Practice 0143692178 Receives reassigned benefits from 18 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, IL; Wayne City, IL
O20230308000409 IL Part A Provider - Rural Health Clinic 0143692178 Practice locations: Mount Vernon, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316663602. Details of each certification follow.

Rural health clinic certification: CCN 148605

Legal name
DEACONESS ILLINOIS CROSSROADS INC
Doing business as
DEACONESS ILLINOIS CROSSROADS FAMILY CLINIC - MT. VERNON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 20, 2019
Last certification
Nov 20, 2019
Ownership / control type
2B
Most recent change of ownership
Jan 14, 2023 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
4101 N Water Tower PL
Mount Vernon, IL 62864-6296
Related CCNs
140294

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.

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
14D1009257Deaconess Il Crossroads Family Clinic - Mt Vernon4101 N Water Tower Place, Mount Vernon, IL 62864Certificate of waiverFeb 10, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 241-8595

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jason Hinkle Individual Corporate DirectorChief Financial Officer Nov 1, 2025 20%
W-2 Managing Employee Nov 1, 2025
Anthony Wielt Individual Corporate OfficerTreasurer Aug 1, 2023 100%
Corporate DirectorBoard Member Aug 1, 2023 20%
Marc J Florence Individual Corporate DirectorDirector Oct 3, 2022
Clifford E Morris Individual Corporate OfficerSecretary Aug 1, 2023 100%
Corporate DirectorBoard Member Dec 12, 2022 20%
William Davis Individual Corporate OfficerPresident Dec 1, 2023 100%
Deaconess Health System Inc Organization, Evansville, IN Corporation, Non-profit Other Jan 14, 2023 100%
Jeffrey a Justice Individual Corporate DirectorBoard Member Dec 12, 2022 20%
Stephen T Titzer Individual Corporate OfficerChair Aug 1, 2023 100%
Corporate DirectorBoard Member Dec 12, 2022 20%
Shawn W McCoy Individual OtherCeo - Chain Home Office Jan 14, 2023 100%
Harold G Clarida Individual Corporate OfficerVice Chair Aug 1, 2023 100%
Corporate DirectorBoard Member Dec 12, 2022 20%
Deaconess Regional Healthcare Services Illinois Inc Organization, Chicago, IL Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Oct 3, 2022 100%

Owners & managing parties with NPI records 2

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.

Change-of-ownership history 1

DateEventCounterparty
Jan 14, 2023 Change of OwnershipThis provider was the buyer Crossroads Internal MedicineCCN 148605, IL, NPI 1447814405

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1316663602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631956",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631956",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646296",
            "telephone_number": "618-244-4313",
            "fax_number": "618-246-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS ILLINOIS CROSSROADS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "HINKLE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "865-599-4770"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deaconess Illinois Crossroads Family Clinic Mt. Vernon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deaconess Illinois Rural Health Clinic Mt. Vernon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.