Community Hospital of Staunton
Organization Active NPI Rural Health Clinic/Center · Staunton, IL
NPI 1508305418 · NPPES record last updated Dec 28, 2023
Key facts
- NPI
- 1508305418
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COMMUNITY HOSPITAL OF STAUNTON
- Practice address
- 325 N Caldwell St
Staunton, IL 62088-1421 - Phone
- (618) 635-2221
- NPI assigned
- Feb 13, 2017
- Organization subpart
- No
Authorized official
- Name
- Larry Spour
- Title
- President
- Phone
- (618) 542-1089
Owners & managing parties with NPI records 1
-
Josh Buschling, D.O.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 3
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 3
-
Josh Buschling, D.O.
-
Ajin Varghese, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1093839 | Community Clinic of Staunton | Certificate of waiver | Jan 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
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
- Corporation · Non-profit
- Incorporated
- Apr 26, 1946 in IL
- Enrollment address
- 325 N Caldwell St
Staunton, IL 62088-1421 - Related CCNs
- 141306
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Rebecca Painter |
Corporate Director |
Aug 18, 2022 | |
| US Department of Agriculture |
5% Or Greater Mortgage Interest | Feb 20, 2017 | |
| Anderson Healthcare |
5% Or Greater Direct Ownership Interest | Jan 1, 2020 | 100% |
| Operational/Managerial Control | Jan 1, 2020 | 100% | |
| Ailee Taylor |
Corporate Director |
Mar 26, 2019 | |
| Josh Parrish Buschling |
W-2 Managing Employee |
Jan 1, 2020 | |
| Lisa Huie |
W-2 Managing Employee |
Feb 12, 2024 | |
| Derrek Tiburzi |
Corporate Director |
Jan 1, 2025 | |
| Patrick J Garvey |
Corporate Officer |
Aug 28, 2023 | |
| Brandi Crawford |
Corporate Officer |
Jul 1, 2023 | |
| William Hanks |
Corporate Director |
Jan 19, 2023 | |
| Michael M Marshall |
Corporate Officer |
Feb 9, 2024 | |
| Tara Cooper |
Corporate Director |
Feb 18, 2025 | |
| Larry F Spour |
Corporate Officer |
Apr 3, 2023 | |
| W-2 Managing Employee |
Apr 3, 2023 | ||
| Michael J Brown |
Corporate Director |
May 18, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170315000002 | IL | Part a Provider - Rural Health Clinic | 3274424031 | Practice locations: Staunton, IL |
National Provider Directory
- Tax ID family
- Community Memorial Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital Clinic/Center | 261QC0050X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Community Clinic of Staunton
Other providers in Staunton, IL
- Thomas Albert Cioni
- Clarkson Optometry Illinois PC
- Michael A Coalson
- Community Hospital of Staunton
- Community Hospital of Staunton
- Community Hospital of Staunton
- Amy Costa
- Justin P Darr
- Tonya Darr
- Davis Chiropractic Center, P.C.
All providers in Staunton, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.