NPIMap

Organization Active NPI

Southern Illinois Healthcare Foundation, Inc.

  • Federally Qualified Health Center (FQHC)
  • Salem, IL
National Provider Identifier
1376588848
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Doing business as
Salem Medical Center
Practice address
1275 Hawthorn Rd
Salem, IL 62881-1028
Phone
(618) 548-4545
Fax
(618) 548-4577
NPI assigned
Jun 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Larry McCulley
Title
Chief Operating Officer
Phone
(618) 332-0783

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1275 Hawthorn Rd
Salem, IL 62881-1028

Mailing address

8080 State St
East Saint Louis, IL 62203-1808
Phone (618) 397-3303

Other identifiers 1

IdentifierTypeStateIssuer
201518OtherILWPS MEDICARE GROUP NUMBER

Other names 1

  • Salem Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031126000641 IL Part B Supplier - Clinic/Group Practice 1456256874 Receives reassigned benefits from 170 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: East Saint Louis, IL; Effingham, IL; Fairmont City, IL; Glen Carbon, IL; Granite City, IL; Greenup, IL; Mattoon, IL; Millstadt, IL…
O20081029000945 IL Part A Provider - Federally Qualified Health Center (FQHC) 1456256874 Practice locations: Salem, IL

Federally qualified health center certification: CCN 141919

Legal name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Doing business as
SIHF HEALTHCARE-SALEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 8, 2001
Last certification
Oct 8, 2001
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 27, 1985 in IL
Enrollment address
1275 Hawthorn Rd
Salem, IL 62881-1028
Related CCNs
141832

National Provider Directory

National Provider Directory
Tax ID family
Southern Illinois Hthca38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Percy McKinney Individual Corporate DirectorBoard Member Apr 22, 2024
Walter Hunter Individual Corporate OfficerVice Chairperson Feb 1, 2008
Gerard Hasenstab Individual Corporate DirectorBoard Member Jan 1, 2019
Dale Fiedler Individual Corporate DirectorBoard Member Jan 1, 2020
Debra Reed Individual Corporate DirectorBoard Member Jan 1, 2021
Larry W McCulley Individual Corporate DirectorChief Executive Officer Mar 17, 1997
Kenneth Hall Individual Corporate DirectorBoard Member Apr 1, 2015
Zoila Marty Individual Corporate DirectorBoard Member Sep 1, 2005
Ethel Manager Individual Corporate OfficerChairperson May 1, 1996
Crysten Calvert Individual Corporate OfficerVice Chairperson Jan 1, 2023
Daniel Winkle Individual W-2 Managing EmployeeAd; May 1, 2025
Anna Marie Nelson Individual Corporate DirectorBoard Member Jan 1, 2010
Richard Sinclair Individual Corporate DirectorBoard Member Aug 1, 2006
Darrel Sterling Individual Corporate DirectorBoard Member Jan 1, 2023
Irma Golliday Individual Corporate DirectorBoard Member Aug 1, 1999

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Touchette Regional Hospital IncCahokia Heights, IL, CCN 140077 Hospital Operational/Managerial Control Jun 30, 2009
Touchette Regional Hospital IncCahokia Heights, IL, CCN 14S077 Hospital Operational/Managerial Control Jun 30, 2009

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1376588848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622031808",
            "telephone_number": "618-397-3303",
            "fax_number": "618-397-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 HAWTHORN RD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628811028",
            "telephone_number": "618-548-4545",
            "fax_number": "618-548-4577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "618-332-0783",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WPS MEDICARE GROUP NUMBER",
            "identifier": "201518",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salem Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, IL

Sources for this page

Verify at the official NPI Registry.