NPIMap

Organization Active NPI

Southern Illinois Medical Services, NFP

Doing business as Logan Primary Care

  • Rural Health Clinic/Center
  • Herrin, IL
National Provider Identifier
1477820900
Registry record updated Apr 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Doing business as
Logan Primary Care
Practice address
405 Rushing Dr
Herrin, IL 62948-3730
Phone
(618) 993-3300
Fax
(618) 993-0262
NPI assigned
Nov 29, 2011
Last updated
Apr 13, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN ILLINOIS HOSPITAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2026

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

Authorized official

Name
Warren P Ladner
Title
Senior VP Chief Financial Officer
Phone
(618) 457-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

405 Rushing Dr
Herrin, IL 62948-3730

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other names 1

  • Logan Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120315000770 IL Part A Provider - Rural Health Clinic 3678677390 Practice locations: Herrin, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477820900. Details of each certification follow.

Rural health clinic certification: CCN 143870

Legal name
SOUTHERN ILLINOIS MEDICAL SERVICES NFP
Doing business as
LOGAN PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 7, 1994
Last certification
Oct 13, 2021
Ownership / control type
2B
Most recent change of ownership
Nov 1, 2011 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 30, 2006 in IL
Enrollment address
405 Rushing Dr
Herrin, IL 62948-3730

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Benton Community Healthcare7 organizations share this tax ID, including this one
Part of
Memorial Hosp Radiology

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Morton P Levine Individual Corporate DirectorBoard Member Jun 21, 1990
Robert L Mees Individual Corporate OfficerChair Jun 28, 2012
Kathleen B Fralish Individual Corporate Director Nov 13, 2006
Southern Illinois Healthcare Enterprises Inc Organization, Carbondale, IL Non-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2011
Southern Illinois Hospital Services Organization, Carbondale, IL Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2011
Operational/Managerial Control Nov 1, 2011
Warren P Ladner Individual Operational/Managerial ControlSVP & Cfo Feb 21, 2022
George M O'Neill Individual Corporate Director Nov 13, 2006
Debra L Braunling-McMorrow Individual Corporate OfficerVice Chair Sep 22, 2011
Daniel Booth Individual Corporate DirectorBoard Member Mar 26, 2022
W E Basanta Individual Corporate DirectorBoard Member Jan 26, 1995
Gina Sirach Individual Corporate DirectorBoard Member Mar 24, 2022
Brad Cole Individual Corporate DirectorBoard Member May 3, 2007
Michael P Tison Individual Corporate DirectorBoard Member Jul 22, 2021
Austin a Lane Individual Corporate DirectorBoard Member May 6, 2021
Steven R Sabens Individual Corporate Officer Mar 24, 2011
John D Antes Individual Corporate OfficerCeo Dec 12, 2022

Owners & managing parties with NPI records 6

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

Facilities with the same owner 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1322524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1477820900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483730",
            "telephone_number": "618-993-3300",
            "fax_number": "618-993-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS MEDICAL SERVICES, NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN ILLINOIS HOSPITAL SERVICES",
        "enumeration_date": "2011-11-29",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A",
        "authorized_official_last_name": "LADNER",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SENIOR VP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "618-457-5200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Logan Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Herrin, IL

Sources for this page

Verify at the official NPI Registry.