NPIMap

Organization Active NPI

McDonough County Hospital District

Doing business as McDonough District Hospice

  • Community Based Hospice Care Agency
  • Macomb, IL
National Provider Identifier
1467410282
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2000933 Issued in IL
Legal business name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Doing business as
McDonough District Hospice
Practice address
525 E Grant St
Macomb, IL 61455-3313
Phone
(309) 833-4101
Fax
(309) 836-1525
NPI assigned
May 2, 2006
Last updated
Oct 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • McDonough District Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467410282. Details of each certification follow.

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
OtherNon-profit
Incorporated
Mar 16, 1955 in IL
Enrollment address
525 E Grant St
Macomb, IL 61455-3313

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Hospice

Medicare Care Compare
Listed as
MDH Hospice,theCCN 141524 · All quality measures
Ownership
Government
Certified
Jan 12, 1989
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
McDonough County20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

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 OfficerCfo Feb 1, 2025
W-2 Managing Employee Feb 1, 2025
William R Murdock Individual Corporate OfficerPresident & Ceo Apr 22, 2019
W-2 Managing EmployeePresident & Ceo Apr 22, 2019

Owners & managing parties with NPI records 10

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

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

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.