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McDonough County Hospital District

Organization Active NPI Community Based Hospice Care Agency · Macomb, IL

NPI 1467410282 · NPPES record last updated Oct 17, 2023

Key facts

NPI
1467410282
Entity type
Organization (NPI type 2)
Primary specialty
Community Based Hospice Care Agency 251G00000X
License
2000933 (IL)
Legal business name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Practice address
525 E Grant St
Macomb, IL 61455-3313
Phone
(309) 833-4101
Fax
(309) 836-1525
NPI assigned
May 2, 2006
Organization subpart
No

Authorized official

Name
Brian E Dietz
Title
President, Ceo
Phone
(309) 833-4101

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 6

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 19

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

Facilities with the same owner 6

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

Practitioners 43

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

View all 43

Affiliated clinicians 13

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospice

Listed as
MDH Hospice,the CCN 141524
Ownership
Government
Certified
Jan 12, 1989
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Hospice certification: CCN 141524

Legal name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Doing business as
MCDONOUGH DISTRICT HOSPITAL
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 12, 1989
Last certification
Oct 11, 2019
Ownership / control type
Government - County
Organization structure
Other · Non-profit
Incorporated
Mar 16, 1955 in IL
Enrollment address
525 E Grant St
Macomb, IL 61455-3313

All disclosed owners & managing parties 3

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

NameRoleSinceShare
McDonough County Hospital District
Organization · Macomb, IL 		5% Or Greater Direct Ownership Interest Jan 12, 1989 100%
Sherri L Hitchcock
Individual 		Corporate Officer
Cfo		 Feb 1, 2025
W-2 Managing Employee Feb 1, 2025
William R Murdock
Individual 		Corporate Officer
President & Ceo		 Apr 22, 2019
W-2 Managing Employee
President & Ceo		 Apr 22, 2019

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
McDonough District Hospital
Macomb, IL · CCN 140089		 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2018
McDonough District Hospital
Macomb, IL · CCN 14U089		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2014
McDonough District Hospital Home Health
Macomb, IL · CCN 147293		 Home health agency Operational/Managerial Control (100%) Oct 22, 2012
Bushnell Family Practice
Bushnell, IL · CCN 148522		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2013
MDH Family Medicine/Convenience Care/Surgery/ENT Clinic
Macomb, IL · CCN 148619		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020
MDH Pediatric Clinic
Macomb, IL · CCN 148617		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100729000608 IL Part a Provider - Hospice 0446140180 Practice locations: Macomb, IL

National Provider Directory

Tax ID family
McDonough Dist Hosp Nuc (20 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2000933 IL Yes

Addresses

Primary practice location

525 E Grant St
Macomb, IL 61455-3313

Mailing address

525 E Grant St
Macomb, IL 61455-3313
Phone (309) 833-4101

Other names

  • McDonough District Hospice Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2023.

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1467410282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553313",
            "telephone_number": "309-833-4101",
            "fax_number": "309-836-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553313",
            "telephone_number": "309-833-4101",
            "fax_number": "309-836-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCDONOUGH COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "309-833-4101"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2000933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McDonough District Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McDonough District Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macomb, IL

All providers in Macomb, IL · Community Based Hospice Care Agency in Illinois

Sources for this page

Verify at the official NPI Registry.