NPIMap

Organization Active NPI

Massac Memorial Hospital

Doing business as Massac Memorial Medical Clinic II

  • Rural Health Clinic/Center
  • Metropolis, IL
National Provider Identifier
1417303181
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MASSAC MEMORIAL HOSPITAL
Doing business as
Massac Memorial Medical Clinic II
Practice address
1204 W 10TH St Ste C
Metropolis, IL 62960-2482
Phone
(618) 524-2182
Fax
(618) 524-8224
NPI assigned
May 11, 2016
Last updated
Jul 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Mrs. Lynn Goines
Title
Chief Financial Officer
Phone
(618) 524-2176

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1204 W 10TH St Ste C
Metropolis, IL 62960-2482

Mailing address

PO Box 850
Metropolis, IL 62960-0850
Phone (618) 524-2176

Other names 1

  • Massac Memorial Medical Clinic II Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000487 IL Part B Supplier - Clinic/Group Practice 3072422799 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Metropolis, IL
O20190227001337 IL Part A Provider - Rural Health Clinic 3072422799 Practice locations: Metropolis, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417303181. Details of each certification follow.

Rural health clinic certification: CCN 148598

Legal name
MASSAC MEMORIAL HOSPITAL
Doing business as
MASSAC MEMORIAL MEDICAL CLINIC II
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 17, 2019
Last certification
May 17, 2019
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Apr 30, 1953 in IL
Enrollment address
1204 W 10TH St
Ste C
Metropolis, IL 62960-2482
Related CCNs
141323

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Massac Memorial Hospita4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1204 W 10th St
Ste B
Metropolis, IL 62960

28 Chick St
Bldg 1
Metropolis, IL 62960

28 Chick St
Ste 0
Metropolis, IL 62960

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Lynn Ann Goines Individual Corporate OfficerChief Financial Officer Jan 1, 2019
Corporate DirectorChief Financial Officer Jan 1, 2019
W-2 Managing EmployeeChief Financial Officer Jan 1, 2019
Operational/Managerial ControlChief Financial Officer Jan 1, 2019
Bharat K Patel Individual Corporate DirectorBoard Member Jan 1, 2019
Maxine Russell Individual Corporate OfficerVice President Jan 1, 2019
Hailey Miles Individual Corporate DirectorBoard Member Jan 1, 2024
Cheryl Vanderford Individual Corporate OfficerSecretary Jan 1, 2019
Patrick Howell Individual Corporate DirectorBoard Member Jan 1, 2024
Donald E Robbins Individual Corporate OfficerChief Executive Officer Jan 1, 2024
Corporate DirectorChief Executive Officer Jan 1, 2024
W-2 Managing EmployeeChief Executive Officer Jan 1, 2024
Amanda Hannan Individual Corporate DirectorBoard Member Jan 1, 2024
Jonathan E Walters Individual W-2 Managing EmployeeChief Marketing Officer Jan 1, 2024
Larry Sommer Individual Corporate DirectorBoard Member Jan 1, 2024
Ricky Griffey Individual Corporate DirectorBoard Member Jan 1, 2024
Keith Jennings Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Massac Memorial HospitalMetropolis, IL, CCN 141323 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 18, 2007
Oct 18, 2007
Massac Memorial HospitalMetropolis, IL, CCN 14Z323 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 1, 2003
Feb 1, 2003
Massac Memorial Medical ClinicMetropolis, IL, CCN 143478 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 1, 2006
Feb 1, 2006
Massac Memorial Integrated Care ClinicMetropolis, IL, CCN 148618 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1417303181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629600850",
            "telephone_number": "618-524-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 W 10TH ST STE C",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629602482",
            "telephone_number": "618-524-2182",
            "fax_number": "618-524-8224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSAC MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-11",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "GOINES",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "618-524-2176",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massac Memorial Medical Clinic II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Metropolis, IL

Sources for this page

Verify at the official NPI Registry.