NPIMap

Organization Active NPI

Southern Illinois Health Care Foundation, Inc.

Doing business as Alton Health Center

  • Federally Qualified Health Center (FQHC)
  • Alton, IL
National Provider Identifier
1376589226
Registry record updated Aug 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN ILLINOIS HEALTH CARE FOUNDATION, INC.
Doing business as
Alton Health Center
SIHF Healthcare
Practice address
4 Memorial Dr Ste 210
Alton, IL 62002
Phone
(618) 463-5905
NPI assigned
Jun 21, 2006
Last updated
Aug 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2018

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

Authorized official

Name
Mr. Larry McCulley
Title
President/Ceo
Phone
(618) 332-0694

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Advanced Practice MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 367A00000X

Addresses

Primary practice location

4 Memorial Dr Ste 210
Alton, IL 62002

Mailing address

2041 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 332-0953

Other identifiers 1

IdentifierTypeStateIssuer
732740OtherILWPS MEDICARE GROUP NUMBER

Other names 2

  • Alton Health Center Doing business as
  • SIHF Healthcare 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…
O20081029000941 IL Part A Provider - Federally Qualified Health Center (FQHC) 1456256874 Practice locations: Alton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376589226. Details of each certification follow.

Federally qualified health center certification: CCN 141886

Legal name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Doing business as
SIHF HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 2, 1997
Last certification
Jun 2, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 27, 1985 in IL
Enrollment address
4 Memorial Dr
Ste 210
Alton, IL 62002-6704

National Provider Directory

National Provider Directory
Tax ID family
South Illinois Hlthcare38 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

Locations

1275 Hawthorn Rd
Salem, IL 62881
Phone (618) 548-4545

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 Director Apr 22, 2024
Walter Hunter Individual Corporate Director Mar 1, 2008
Gerard Hasenstab Individual Corporate Director Jan 1, 2019
Dale Fiedler Individual Corporate Director Jan 1, 2020
Debra Reed Individual Corporate Director Jan 1, 2021
Larry W McCulley Individual Corporate Officer Feb 1, 2011
Kenneth Hall Individual Corporate DirectorBoard Member Oct 1, 2018
Zoila Marty Individual Corporate Director Sep 1, 2005
Ethel Manager Individual Corporate Director May 1, 1996
Crysten Calvert Individual Corporate Director Jan 1, 2023
Daniel Winkle Individual Operational/Managerial Control Jan 1, 2025
Anna Marie Nelson Individual Corporate Director Jan 1, 2010
Richard Sinclair Individual Corporate Director Jul 1, 2006
Darrel Sterling Individual Corporate Director Jan 1, 2023
Irma Golliday Individual Corporate Director 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 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1376589226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 GOOSE LAKE RD",
            "city": "SAUGET",
            "state": "IL",
            "postal_code": "622062822",
            "telephone_number": "618-332-0953",
            "fax_number": "618-332-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 210",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-463-5905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTH CARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "618-332-0694",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "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": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WPS MEDICARE GROUP NUMBER",
            "identifier": "732740",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alton Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SIHF Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.