NPIMap

Organization Active NPI

Kirby Medical Center

  • Rural Health Clinic/Center
  • Cerro Gordo, IL
National Provider Identifier
1508219288
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KIRBY MEDICAL CENTER
Practice address
407 South Jackson Street
Suite a
Cerro Gordo, IL 61818-4356
Phone
(217) 763-6010
Fax
(217) 763-6012
NPI assigned
Jul 19, 2016
Organization subpart
Yes
Parent organization
KIRBY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Authorized official

Name
Jennifer Moss
Title
Ceo
Phone
(217) 762-1501

Specialties & licenses 1

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

Addresses

Primary practice location

407 South Jackson Street
Suite a
Cerro Gordo, IL 61818-4356

Mailing address

1000 Medical Center Dr
Monticello, IL 61856-2116
Phone (217) 762-2115

Other names 1

  • Cerro Gordo Rural Health Clinic Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kirbyhim@kmc.kirbymedicalcenter.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171226001002 IL Part A Provider - Rural Health Clinic 6901791144 Practice locations: Cerro Gordo, IL

Rural health clinic certification: CCN 148566

Legal name
KIRBY MEDICAL CENTER
Doing business as
CERRO GORDO RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 29, 2016
Last certification
Dec 29, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
407 S Jackson St
Ste a
Cerro Gordo, IL 61818-4360
Related CCNs
141301

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

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
Part of
John and Mary E Kirby E

Locations

407 S Jackson St
Ste A
Cerro Gordo, IL 61818
Phone (217) 763-6010

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
Michael Atwood Individual Corporate DirectorBoard Member Nov 1, 2017
Shannon Williams Individual Corporate DirectorPatient Financial Services Sep 5, 2013
Charles Scott Wilkin Individual Corporate DirectorBoard Member Sep 26, 2023
Michelle Gross Individual Corporate DirectorBoard Member Nov 1, 2017
OtherTreasurer of the Governing Board Mar 18, 2020
Thomas Scaggs Individual Corporate DirectorBoard Member Nov 6, 2023
Jennifer Moss Individual Corporate DirectorCeo Apr 6, 2026
Operational/Managerial ControlCeo Apr 6, 2026
Kandace Heistand Individual W-2 Managing EmployeeMedical Staff Coordinator Mar 20, 2025
David Brown Individual Corporate DirectorBoard Member Feb 1, 2021
Gary Huisinga Individual Corporate DirectorChairman of the Board Jan 1, 1994
Luke Feeney Individual Corporate DirectorBoard Member Sep 1, 2020
Karla L Bradley Individual Corporate DirectorVice Chair of the Board Jan 17, 2014
David M Remmert Individual Corporate DirectorBoard Member Nov 1, 2021
Kirby Medical Center Organization, Monticello, IL Corporation, Non-profit Other Sep 15, 1992
Kimberly Ann Alvis Individual Corporate OfficerCfo Jul 16, 2018
W-2 Managing EmployeeCfo Jul 16, 2018
Stacy Poundstone Individual Corporate DirectorHealth Information Management Jun 9, 1987

Owners & managing parties with NPI records 8

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
Kirby Medical CenterMonticello, IL, CCN 141301 Hospital Other Sep 15, 1992
Kirby Medical CenterMonticello, IL, CCN 14Z301 Hospital Other Sep 15, 1992
Atwood Rural Health ClinicAtwood, IL, CCN 143438 Rural health clinic Other Sep 15, 1992
Kirby Medical GroupMonticello, IL, CCN 143495 Rural health clinic Other Sep 15, 1992

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 83

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

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780272000000",
    "number": "1508219288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER DR",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618562116",
            "telephone_number": "217-762-2115",
            "fax_number": "217-762-1542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 SOUTH JACKSON STREET",
            "address_2": "SUITE A",
            "city": "CERRO GORDO",
            "state": "IL",
            "postal_code": "618184356",
            "telephone_number": "217-763-6010",
            "fax_number": "217-763-6012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRBY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIRBY MEDICAL CENTER",
        "enumeration_date": "2016-07-19",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-762-1501"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kirbyhim@kmc.kirbymedicalcenter.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "407 South Jackson Street",
            "address_2": "Suite A",
            "city": "Cerro Gordo",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618184356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cerro Gordo Rural Health Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Cerro Gordo Rural Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cerro Gordo, IL

Sources for this page

Verify at the official NPI Registry.