NPIMap

Organization Active NPI

Community Hospital of Staunton

Doing business as Community Clinic of Staunton

  • Rural Health Clinic/Center
  • Staunton, IL
National Provider Identifier
1508305418
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY HOSPITAL OF STAUNTON
Doing business as
Community Clinic of Staunton
Practice address
325 N Caldwell St
Staunton, IL 62088-1421
Phone
(618) 635-2221
NPI assigned
Feb 13, 2017
Last updated
Dec 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Larry Spour
Title
President
Phone
(618) 542-1089

Specialties & licenses 2

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

Addresses

Primary practice location

325 N Caldwell St
Staunton, IL 62088-1421

Mailing address

325 N Caldwell St
Staunton, IL 62088-1421
Phone (618) 635-2221

Other names 1

  • Community Clinic of Staunton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170315000002 IL Part A Provider - Rural Health Clinic 3274424031 Practice locations: Staunton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508305418. Details of each certification follow.

Rural health clinic certification: CCN 148580

Legal name
COMMUNITY HOSPITAL OF STAUNTON
Doing business as
COMMUNITY HOSPITAL OF STAUNTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 20, 2017
Last certification
Oct 20, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 26, 1946 in IL
Enrollment address
325 N Caldwell St
Staunton, IL 62088-1421
Related CCNs
141306

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

Other NPIs with the same Medicare PAC ID 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1093839Community Clinic of Staunton325 N Caldwell Street, Staunton, IL 62088Certificate of waiverJan 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hospital4 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.

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Rebecca Painter Individual Corporate DirectorVice President, Board of Trustees Aug 18, 2022
US Department of Agriculture Organization, Jacksonville, IL 5% Or Greater Mortgage Interest Feb 20, 2017
Anderson Healthcare Organization, Maryville, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Operational/Managerial Control Jan 1, 2020 100%
Ailee Taylor Individual Corporate DirectorSecretary, Board of Trustees Mar 26, 2019
Josh Parrish Buschling Individual W-2 Managing EmployeeMedical Director Jan 1, 2020
Lisa Huie Individual W-2 Managing EmployeePFS Director Feb 12, 2024
Derrek Tiburzi Individual Corporate DirectorPresident, Board of Trustees Jan 1, 2025
Patrick J Garvey Individual Corporate OfficerCfo Aug 28, 2023
Brandi Crawford Individual Corporate OfficerDirector of Nursing Jul 1, 2023
William Hanks Individual Corporate DirectorMember, Board of Trustees Jan 19, 2023
Michael M Marshall Individual Corporate OfficerCeo Feb 9, 2024
Tara Cooper Individual Corporate DirectorMember, Board of Trustees Feb 18, 2025
Larry F Spour Individual Corporate OfficerCeo Apr 3, 2023
W-2 Managing EmployeeCeo Apr 3, 2023
Michael J Brown Individual Corporate DirectorTreasurer, Board of Trustees May 18, 2023

Owners & managing parties with NPI records 1

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1508305418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 N CALDWELL ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881421",
            "telephone_number": "618-635-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N CALDWELL ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881421",
            "telephone_number": "618-635-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL OF STAUNTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "SPOUR",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-542-1089"
    },
    "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": "Community Clinic of Staunton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Clinic of Staunton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staunton, IL

Sources for this page

Verify at the official NPI Registry.